HomeMy WebLinkAboutMortgage_Smith (40) •^•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
f-tCra FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
4` State Form 43709(R12/6.14)
•" i' Prescribed by Department of Local Government Finance
INSTRUCTIONS: F I L ID\
To be filed in person or by mail. omr sled 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 pr w If 0 20 60 County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2). obile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
v ere the property is located during the twe r e(12)months before March 31 of each year the deducts j,is sou•r.
See reverse sic!, for additional instructions and qualificati> . I r' el"?PI
Applicant o i -r or con ct buyer eyes f on rave : de)i G SSUN CVU FY AUDITOR
�- d ,2 ••er/ egal descd n Record number Page num
�1 �, -/ _07- dad-X/• 9,7603F ico 1 -11q
>•value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract tii9/dJ�btedness unpaid as of Is the applicant the sole
March 1,current year March 1,anent year date of app Gca fr � legal or equitable owner?
❑ 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 a nt than that of app indicate below Is property in question:Annually Assessed
y�/ /_ . 9B Real Property ❑
Mobile 6
�l%t.�L rvy (�(�Y/( d.-/Z-1-
J Mobile Home(IC 6-1.1-7)
Name of mortgage or contact 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
a', ;�
Address of assignee(number and street,city state,and ZII - O /I r1
Drawer NO CCVV//��� 111 \{
Does applicant own property in any If yes,what county? guested If yes,state amount of deduction
other county I
in Indiana? ❑Yes 0 N Card NO. ` '\� III No
A person is not entitled to this deduction unless the p debtedness that is recorded in the county
recorder's office(including any home equity line of cr a 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.
Signatur can/er' full n me Date(month,day,year)
Fu sir) Odra f a cant(nu . rand street,city,state,and ZIP code)
Person authorized by duty exe ted Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,}rear)
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 310,000.