HomeMy WebLinkAboutMortgage_Schafer (9) 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
:e._- - _ FOR DEDUCTION FROM ASSESSED VALUATION g
• State Form 43709(R12/6-14) Jp E
•. / Prescribed by Department of Local Government Finance �`-'
INSTRUCTIONS: File Ma((ttr''kr�1
To be Red in person or by mail. MAR 2 1 FZM"ed with:
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 i fYor
located on or before January 5 of the immediately succeeding calendar year. ounry Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co UNTY AUDITOR
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where the property is located during the twelve(12)months before March 31 of each year the dediA3kBSQNIr�hp
See reverse side for additional instructions and qualifications.
Applicant ner contract uyer-see restrictions on reverse side)
xing Distc K�y number al descnp'•ion Record number Page number
T acs- la — « aDo - No ,..4 ��- �7 0O! 40 ► (.5.5
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?1 1 ) (D DD v ❑ Yes ❑ No
I 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: I the property in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Nam mortg--age-ewwor contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) _ _____-
Name of assignee or other owner or holder of mortgage ‘/\/ Le ' t e.( O t-N---- O.
Address of assignee(number and street,city,state,and ZIP cot SC�it:.__. E� J n C
Does applicant own property in any If yes,what county? C"' �� 1 U '3_'aq- \(E3 uested If yes,sate amount of deduction
other IEl county
in 5 ❑No
n ndiana? ❑Yes No ^ Q b_ `1
A person is not entitled to this deduction unless the perso d- - _ .,eJebtedness that is recorded in the county
recorder's office(including any home equity line of credit; ..___..,,,,e 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 Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(own full name) Date(month,day,year)
v-- .A
Fujyresident address of applicant(number and street,city,state,and ZIP code)
Person 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 510,000.