HomeMy WebLinkAboutMortgage_Linder :ana STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township Year
`a.:-1F FOR DEDUCTION FROM ASSESSED VALUATION i }
-..--:,:=- ".4. State Form 43709(R12/6-14) F I�„/ ,
' ' Prescribed by Department of Local Government Finance
INSTRUCTIONS: MAY 2 7 2016 File Mark
To be fled in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the dedu# on is so ht.
Must be filed or postmarked with the County Auditor or County Recorder of the cour ' erty is ❑ County 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 wit Ig$.fAtf. hJ7Ythst- 9 R
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner tract b i-r-see restrictionsrgirs and M� (�-yr2
Taxing striet Key n .ber/legal description Record numb r Page n m
/,L�viz -G/7/��mt 6 JOG /6 3 m 3a 92- ao i / 9
Assessed" value of properly as of �Mortg tract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current r date of application legal or equitable owner? •
/D 700 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
)fr$Real Property ❑ Annually Assessed
,,pp Mobile Home(IC 6-1.1-7)
Name of mo agee contract seller/ /if
/i i• C r Uri
Address of mortgagee oo antract seller(n ber and street,city,state,and ZIP code) `/�1,, _
Name of assignee or other owner or holder of mortgage \ r 1( G ///���L( n ot e(-
Address of assignee(number and street,city,state,and ZIP code) J 1 0 vl t_,..0 O
Does applicant own property in any If yes,what county? What Taxing District? 1 / 'deduction
other county 5� 12-// ,
other
Indiana?county ❑Yes ❑No �-(
A person is not entitled to this deduction unless the person has a balance on the l a the county
recorder's office(including any home equity line of credit that is recorded in the cc __. _ ____,
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 perju s. at the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer o$ e aforeme -d_Property on date application is filed.
i'WtA' ()� er's/ufl name) _ Date(month.day,year)
ent address of a• h -• ap2Ttreet,city, tat r/Z� ode)
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.