HomeMy WebLinkAboutMortgage_Currier •
�.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County Township Year
�,<°,p FOR DEDUCTION FROM ASSESSED VALUAT L y}�
,: . f" Stake Form 43709(R12/6-14) 1�J
',:',"Ti. Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
2O i5
S E P 2 ].
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 the deduction is sought.
Must be filed or postmarked with the County Auditor or County Reconie . the coo ty - . -property is ikli County Auditor
located on or before January 5 of the immediately succeeding ca/end.•, fy -4rlgi j;
2) Mobile/Manufactured Homes not assessed as Real Property ' - he county County Recorder
where the property is located during the twelve(12)months befOrre7aa�, 3 • -ach year me a 'on is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions o verse s
cw r. <2.. C u r r i e r
TaxinyiDishict Key number/legal description Record number Pa a ben
QUb a t- 3-o 4- Goo ezro •43 Q) • joie e017
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?
// 7 00 0 ❑ 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 It t124 property in question:Annually Assessed
Meal ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name mortgagee or contract seller /�
e/ -if �4/n
an n Al r) e orf
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county „ properly for
in Indiana? Yes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in 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 for the deduction.
COUN - -- — —
Deduction approved in the amount of: _. ,0 `' go c-
20
20 20 20 20_ ` `1'-1 - (5 20
Jo..\r..k ( C,�Y r i Q ,r
Signature of County Auditor l r� I
\ o Co k V3 c,
II We certify under the penalty of perjury that the above and foregoing ink 4r \ 1, t 0 O 6 of Indiana and
owner/..ntract buyer of th orementioned property on date application._...__.
ySignatu - /• - s fW a•,- Date(month,day,year)
Fur -dent address•f abpGrant(num r and street,city,state,and ZIP code) g ���/`��
-fir s• 7C4✓r 49.-sSrsrr , /•r' '17f'3,
rson 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.