Loading...
HomeMy WebLinkAboutMortgage_Huey STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township 1 Year ft ° FOR DEDUCTION FROM ASSESSED VALUATION "r )s`" 1 State Form 43709(R12/6-14) r Prescribed by Department of Local Government Finance INSTRUCTIONS: -- aFile Mark To be filed in person or by mail. fil Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought - �J. -� Must be filed or postmarked with the County Auditor or County Recorder of the county where the p e Auditor located on or before January 5 of the immediately succeeding calendar year. 'County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cot jpf 1 5 7016 where the property is located during the twelve(12)months before March 31 of each year the deduction is t. See reverse side for additional instructions and qualifications. /� Applicant(owne ontract buyer-see restriction n reverse side) �� /I[__ ' '� t lt7 'd1l-' GIB O]NJYIC?ail NTY a ITOP Taxing District K n tuber/le al description Rewrd ber Pag numbe� - I1)-is- aot -coo egg-oaa �v 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,anent year March 1,current year date of li uon�? legal or equitable owner? . / �f3o� ❑ 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 cl Address of mortgagee or contract seller(number and scree, state,and ZIP code) Name of assignee or other owner or holder of mortgage ///��� a_.1.-.....,wp��y.p,w',,.. Address of assignee(number and street,city,state,and ZIP co / I Q�s) (P `- Does applicant own property in any If yes,what county? rr r-„ O I quested If yes,state amount of deduction other cou?ty ❑No �fjjQt1Fy`t cf+x-+' N Indiana? ❑Yes ••,•••,•.....• ❑No A person is not entitled to this deduction unless the persc tebtedness that is recorded in the county recorder's office(including any home equity line of credit 1t 9/p e basis for the deduction. C.,rrl-`t.C1-....,..1,. Luc Deduction approved in the amount on 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 I contract buyer of the aforementioned property on date application is filed. Si lu s full name) Date(month,day,year) Fu I. t.•ress of applicant(number street„,statue and ZIP code) © e- 1RL d Etg7(o(o3 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 S10,000.