HomeMy WebLinkAboutMortgage_Collins (11) 7;"1-$. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION V.---,;--
.:� f" State Form 43709(R72/6-14)
\ ; ' Prescribed by Department of Local Government Finance .
INSTRUCTIONS: izt
To be tiled 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 ���III
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pro is9 2118 County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deductio c sou•hti al—
See reverse side for additional instructions and qualifications. I • -*Mi•
Appli t(owner or contract buyer-see/r1estrictions on reverse s' e) t GIBSUN COON I Y AUDI I UK
Taxing District Key numbe egal description Record number Pa number
d a 6 — // 7 g— 300 — ooy, a /n —o ff/ /730/r s—
Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfi ant the sole
Mardi 1,current year f March 1,current year date of appG Lion legal or equitable owner?
. Apt, 0 O ❑ 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 or contact seller �•. G
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 _ I on property for
in Indiana? ❑Yes ❑No _ current year? ❑Yes ❑No
A person is not entitled to this deduction unless the pr "Arson's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of cr Alike)that is the basis for the deduction:
Dr
Deduction approved in the amount of: 0••. 1a�O/2!.""
20 20 Card ••••• .rS 20 20
Signet re of County Auditor ` •l V ••• • Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoinguo..,.._ that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature �� Date(month,day,year)
`(uG ador� .nt(number.n8 street,city state,and ZIP code) r
.� `t '30a W 35o S J.-- Y76 4 5-
P •n authorized by duty 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.