HomeMy WebLinkAboutMortgage_Utley <0..54.7 STATEMENT STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION 1' T T f
' State Fonn 43709(R72 Boa) 1
Prescribed by Department of Local Government Finance ( _`/
INSTRUCTIONS: File Mark
To be filed in person or by mail. MAY %• r r:E Is the
Filing Dates: 1) Real Properly: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 is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. �'1 •/ Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must rile with the County Auditor of the coun °�� �' ty
where the properly is located during the twelve(12)months before March 31 of each year the deductioc, Skith.0• . . - . : : _
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
DAVID E. UTLEY
Taxing Key number I legal description R p�u�q r P �v �q
�' .I5� 4D.-IC -I(x, _oce.osq,ca--Ly Qt UW 1041/ p UlC 1
Assessed value of real property as of Mortgage/Contract indebtedness unpaid a of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1.current year March 1,current year datfe fgpplication legal oreequi le owner?
S OO v L4'Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone o er than spouse.indicate with whom
If name on record is different than that of applicant,indicate below: Is the operty in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name ogjtgqgee or contract seller
!l rn am • 'I c an\
Address ofNmortgagee or contract seller(number and ty.stat aired/ZZIP od ) jJ
Name of assignee or other ownwn'er/yorr holder of mortgage
J v�
Address of assignee(number and street,city,state,and ZIP code)
e
Does applicant own property in ny If yes.what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 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 20
Signature of County Auditor County Date(month,day,year)
I 1 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(owner's full namenn Date(month,day,year)
X 05/13/2016
Full resident address of applicant(number and street,city state,and ZIP code)
11192 OWENSVILLE RD HAUBSTADT IN 47639
Person authorized by duty 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$10,000.
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