HomeMy WebLinkAboutMortgage_Mowrer -7-.o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
.e s FOR DEDUCTION FROM ASSESSED VALUATION -- I
��i' State Form 43709(R12(6i14)
FILE
� v, Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. MAR prrtl turn with.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. MAR 1 CU IU
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. • r _,.. -ecorder
r.bile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cou•!9,,, Br jrRfq,
v ere the property is located during the twelve(12 months before March 31 of each year the deducSti8. ,!• 0 UNTY AUDITOR
See reverse sid='or additional instructions a qualific/ations.
Applica (o •-r cacont t buyer ee restfcb son reverse sid /1-Z. V) 0 eiVE6"
:xih•D Key m r/legal description/ Record number Page num r
dx d-/O cr -d6O -40/. /7. fl /(0 A
Assessed v. e of real rope as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant le
March 1,••rent y / March 1,current year date of application __ o legal or equitable owner?
`
(v//] de.P ado ❑ Yes ❑ No
If no, •.t is his/her exact re 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 property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller' 'sn/(
Address of mortgagee or contract seller(number and street,city,state,and ZIP c e)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
074—d 1
Does applicant own property in any If yes,what county? 1 What Taxing District Has is deduction been requested If yes,state,,,aaatttnnnount o deduction
inInd county on current property for 7f
in Indiana? ❑Yes ❑No current yeah ❑Yes ❑No • O( (/i gl..i
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness th t 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 Count'Auditor 1 County
mDWI t K2toTbP►.W.
I/We certify under the penalty of perjury that the above and foregoing information is true t W land
fpowner/contract bu�r�r of the aforementioned property on date application is filed. L EA LI- 1
`gnatur- -r's f :a eC_-
ull reside add -ss of applicant(number and street, i •,state,and ZIP code)
1C a-d try "r7er 4, oklejc .r A, —.VC/ 661
Person authorized by duly executed Power of Attorney or by IC 6-1.-f-12-0.7
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.