HomeMy WebLinkAboutMortgage_Young (5) •°•r• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
z FOR DEDUCTION FROM ASSESSED VALUATION ��-
�� � State Form 43709(R721644)
*�, / Prescribed by Department of Local Government Finance
1 I ( i
INSTRUCTIONS: S j Fitd •-r 1"
To be filed in person or by mail. -orrn, ea with:
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought. �,7
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properARR 1,1 2 u 6County Auditor
2 located on or before January 5 of the immediately succeeding calendar year. County Recorder
) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAuditor of the co my _
where the property is located during the twelve(12)months before March 31 of each year the deduction f-. u•ht. Brit—
See reverse side for additional instructions and qualifications. 6) - -refit
Aopll9aa!jo• n r buyerye / s o reverse sip) ( //ii� - GIBSON GOur. I 'r AUDITOR
T g nct Key oawherr 1pna�ccrrin±inn / n I Reco�d number Page nea y�
(2114 --I 5440- 6)-'" t�/. o 9- I5S
Asmssed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract Indebtedness unpal as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equable owner?
es ❑ No
If no,what is his I 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 AscPcsed
al: al Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
N tt mortgagee or contra ller /
Address of mortglgep or contract seller(number and street,city,state,and ZIP code) �7
act 29 1/V t,*,A�p,r u y f pc. 5- 3 S-a D, `i, /Ai Yo27
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 r� on property for
in Indiana? ❑Yes 046 current year? ❑Yes [iGo
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 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,propertybn date application is filed.
SI nat w el-f'.1 name) Date(mont,day, ear)
Full r &dent a• ress p 11cent(number and street,city,state,and ZIP code)
/3�3/ El .2o d s Duel,},-,o O/ 7C6&- 76,0e7
Person auth zed 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 sheet 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.