HomeMy WebLinkAboutMortgage_IgleheartI i^•�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
E_ ; FOR DEDUCTION FROM ASSESSED VALUATION
fit j State Form 43709(R12/6-14)
\ % Prescribed by Department of Local Government Finance FILElb
INSTRUCTIONS: File ggMarie
To be filed in person or by mail. MAR lot t2446th:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
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. • I r „' Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must tile with the County Auditor of the count -vmrlh
where the property is located during the twelve(12)months before March 31 of each year the deductioli7(.C• 1 1 • • 1 1 @ -
See reverse ..- or additional instructions and qualifications.
Applicant • er• contract buyerp restri dill revers si e)
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Tlist / Key ••er/legal de • on Rem number Page num
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Assessed value of - as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract tiindebtedness unpaid as of Is the applicant the sole
March 1,current March 1,current year date of appl' legal or equitable owner?
/t ❑ 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 contract seller
Address of mortgagee or contract seller(numbe and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage //////���))) r
Address of assignee(number and street,sty,state,and ZIP code) . / /� / `( / p�oi,
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? ❑
Ill 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 1
�\I I L • �\e`�C. 114
I/We certify under the penalty of perjury that the above and foregoing information is true and r 1 �^
/ owner/contract buyer of the aforementioned property on date application is filed. \-o 9 it- J CA vw(�
S Signature wnefs;Wl name) r O bop O _
l� � ('`�� \ b ` . 100
Full address of applicant(number street,city,�state, c o)n-) S- �O \ S ` 1I qq
e, S I� tf71n • 15
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 •
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.