HomeMy WebLinkAboutMortgage_Young (21) �no STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count I Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
r' State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance -
INSTRUCTIONS: Fil
To be filed in person or by mail. - - r i )'th:•
Filing Dates: 7) 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 prop gy,t o n (fin County Auditor
located on or before January 5 of the immediately succeeding calendar year. R o D "�!4 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county 1
where the property is located during the twelve(12)months before March 31 of each year the deduction .ought.
See reverse side for a itional instructions and qualifications. .. • VMHt
Applicant(owner or contr t b u y e r-see restgc ions r verse side) • : 8 I.COUNTY AUDITOR
Taxing District Key number/I�description Record number Page number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,pwrr r.year, - date of application legal or equitable owner?
( //VI�U� III Yes ❑ No
1 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 applica ,indicate below: Is the properly in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobie Home(IC 61.1-7)
Name of mortgagee or 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
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? 1 What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes El No current year? ❑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 I 20
Signature of County Auditor County Date(month,day,year)
I 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.
.gnature(ownv�ame) Date(month,day,year)
I II resident 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.