HomeMy WebLinkAboutMortgage_Dewig (3) ."r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN $
�. .•{ °'f IL g�(j ounty Township Year
`�t FOR DEDUCTION FROM ASSESSED VALUATI
�: . .4�� State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: SEP 9 2015 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which me deduc' n i gft.
Must be filed or postmarked with the County Auditor or County Recorder of the property is County Auditor
located on or before January 5 of the immediately succeeding calendar ye t e'If'1)-mR ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:MuGflieditRaeloNtjt AdaRbrof the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant( r or b e irons on rove. a side)
Tatar Distri Key number/legal desrsiption Record number Page number
2. /9i9- a -ooi. a95- 0Q46 �i 3 O _
Assessed value of real pivpwrty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
Ilia 95 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is�the property in question:Annually Assessed
}Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or conb-arlerr`^
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
(n
Address of assignee(number and street,city,state,and ZIP code)'/"n°``U..•
Does applicant own property in any If yes,what county? What Taxing District I _ 3`r}o O t I - `-v/sqs" deduction
other county / /.
in Indiana? 111 Yes ❑No �/r6-a`/
A person is not entitled to this deduction unless the person has a balance on the pers '-'l C r rl rn the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis cur wt.
COUNTY AUDITOR .
Deduction approved in the amount of.
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sgnature(owner's) A Date(month,day,year)
-
Full resident address of applicant(number and street,city,state,and ZIP code)
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.