HomeMy WebLinkAboutMortgage_Helsley •^(r. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township Year
FOR DEDUCTION FROM ASSESSED VALUATION F AL
..�. 14 State Form 43709(R12/6-14)
S „„ ! Prescribed by Department of Local Government Finance
•INSTRUCTIONS: 16 2-013 File Mark
To be filed in person or by mail. OCT l• Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is soug .
Must be filed or postmarked with the County Auditor or County Recorder of the county ,-re •-��r.7f j ii` is County Auditor
located on or before January 5 of the immediately succeeding calendar year. .„ ry pp0p)TOR ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with th ►.pQk� [r2 Lbunty
where the property is located during the twelve(12)months before March 31 of 1,6 year the deduction is sought.
See reverse side for additional instructions and qualifications.
Appligrf0(owner or contra buyer-s restrictions on reverse 'de)
Tax; is Key number/legal description Record numb" Pa,g4umbe
CQ.itl ! '6 -/3-33-/Qc ago o70 V 4O/� %7;
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?
,51 00 6 ❑ 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 mo ag 1246 le\J tc.o 1. U
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 on property for
in Indiana? ❑Yes II]No current year? ❑Yes 0 N
A person is not entitled to this deduction unless the person hasa.balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(includinn-nn"h"-.^- -.'- - ) 'e county recorder's office)that is the basis for the deduction.
pp 15131 JA YAUDITOR .
Deduction approve Iv /� l A r
20 - m�' a ///���""" 20 20 20
Signature of County County y Date(month,day,year)
I/We certify un V W1 .._..nation is true and correct and that the applicant is a resident of Indiana and
owner/contr a ._,_. _.....,a,,.,ewenuon property on date application is filed.
Signature(o ame Date(month,day,year)
Full res' en d ess of app cu (nun rand street,city,state,and ZIP code)
Perso 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$10,000.