HomeMy WebLinkAboutMortgage_Dejarnett -1744 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
` . 4 FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
File Mark
To be Red in person or by mail. F
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. t
Must be filed or postmarked with the County Auditor or County Recorder of the county where the p rty •: "Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the carQ1{p�
where the property is located during the twelve(12)months before March 31 of each year the deduction is d >it.h' .. 2015
See reverse side for additional instructions and qualifications.
Applicant caner or tract buyer-see restriction reverse side ((��
Taxing District ey numb legal description aIFSQRem3�nu4 ,Y er
/6 - a-o ? - 403 -tt0• !o3-oa$ 15 11
Assessed value of real properly as o Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,curren�egr- date of application legal or equitable owner?
❑ 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 o contract Belle
Address of mortgagee or contract seller(num and street,city,state,and ZIP code)
Name of assignee or other owner or holder o 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 ,—, property 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.
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 erjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contra;: of the mentioned property on date application is filed.
own- ) Date(month,day,year)
air
F eside gligr o ppficant(number and street, thsiafe,and ZIP code) fe
.. I ! . . - ral � l - •
Person authorized by duly executed Power o •ttomey or by IC 6- .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.