HomeMy WebLinkAboutMortgage_DeBord an. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
/ -'` FOR DEDUCTION FROM ASSESSED VALUATION
rp " i` State Form 43709(R121 6-14) -
'--Wet Prescribed by Department of Local Government Finance 11111E i a in
INSTRUCTIONS: F of .. :'.J
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. S
Must be filed or postmarked with the County Auditor or County Recorder of the county when the property sP JO �Y1.1J County Auditor
located on or before January 5 of the immediately succeeding calendar year. A ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the •., nty.
where the properly is boat:. .• 'ng the twelve(12)months before March 31 of each year the dafuctlo �'f.,r t.j.f��/
See reverse for additional instructions and.ualfiratons. SONS:-
ON COUNTY�UOIT
Apar.-nt • c o n, bbu7yer—r-see reeiuictio .on reverse side) UR
axing D'- ' / Key ber/leg scription Record number Page•.tuber
fakes 9C7 7o/- CIO — 04 50 5` Oz/ 01O/5— 7 oi
>•value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March ,anent year March 1,current year date of gpy pr �f /00 legal or equitable owner?
U"// p)7 J/- 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: Is th property in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
• rte
Address of mortgagee or contract seller rand 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 on 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(Includinnn�nnv-LhnIme.nauity line of credit tthJJat is recorded in the county recorder's office)that is the basis for the deduction.
1 ICt,Vj 9'truLta 3. T123 Q /947, OR •
Deduction approved in th r
20 Drawer N O..a&Q 1 5 20 20 20
Signature of County Aud �'
. y Date(month,day,year)
N
Card O.
I I We certify undei 'L n'rY f I -ui >_O -) is true and correct and that the applicant is a resident of Indiana and
owner I co tract buyer of th afore en ea property vn uc.c app....0.,..,.
IN Signature is Date(month,day,year)
J Full re d addressnt'umber and street,city.state,and ZIP code) //��/�
1 .
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-07 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$10,000.