HomeMy WebLinkAboutMortgage_Gladish " ". STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES . 11ty Township Year
t t FOR DEDUCTION FROM ASSESSED VALUATION 11...) �'
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•:-a=- Stare Form 43709(R72/E74)
-„, Prescribed by Department of Local Government Finance
2v\5 File Mark
INSTRUCTIONS: SEP 10
To be filed in person or by mail. Form sled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is .
Must be filed or postmarked with the County Auditor or County Recorder of the co rq.6R ..ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. NN-[Y Niu ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with(((�� ffipqtarytftfXl4ddor of the county
where the property is located during the twelve(12)months before March 3&3f'Jccn year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner
° ^tract buyer-see restriUigns on reverFeicide) n
Taxing District �a�Key number/legal'rd`escriiptionx//-4�L. _QOC�� ,1fLj Record number Page number
a to rll- 1s -3ao cna. gGy -oa7 ao 3537 (P
Assessed value of real property 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?
/30ooO ❑ 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
)eal Property ❑ Mob Annually Assessed
ile Home(IC 6-1.1-7)
Name of mortgagee or contract seller g.7e 0
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) \
aIS,
Name of assignee or other owmer or holder of mortgage S r
Address of assignee(number and street city,state,and ZIP code) _I\in 0 I S)_ I
IO S 1
z ° E` —
Does applicant own property in any If yes,what county? What Taxing District? h_ I"3 o b ( t`C'I I
other county on props..., `l
in Indiana? ❑Yes ❑No current year? _ • O 1
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract me,.. • O U ty
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis w. . •
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 I contract buyer of the aforementioned property on date application is filed.
Signature(owne . Dname) /J2 Date(month,day,year)
un resident address licant(number and street,city,state,and ZIP code)
Person authorized by duly executed Power of Attorney 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.