HomeMy WebLinkAboutMortgage_Rolley (2) •^•4q STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14) - FIT
•'e „„ 1J Prescribed by Department of Local Government Finance A fr !
INSTRUCTIONS: File Mark
To be filed in person or by mail. JUN I orm '•, ;h:
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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. �. .� � +:unity Recorder•
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of(yy 1 ���
fir• • e�
where the property is located during the twelve(12)months before March 31 of each year the deduction is �•(•�� - OR
See reverse side for additional instructions and qualifrcati s
Applicant owner con %buyer resVi on re rs si//
T/ g District /l.•, Key n ?her/legal d 'ption Record?umber Pa�g�u er
4� \QS a6 - oz, -/y- (do - 00o. d� 0/ 7 Il0 �r�( 3
l value of real property as of Mortgage/Contract ind btedness unpaid as of ortgage I Con• ct in ess unpaid as of Is the applicant the sole
a
March 1,current year March 1,current year date of appli //,, UD legal or equitable owner?
�VU . ❑ 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 property in question:Annually Ascncced
Real Property ❑ Annually Assecced
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
s��n
Address of mortgagee or contract seller(number and street,city,state,an d
IP code)
Name of assignee or other owner or holder of mortgage yx ,s(f-/— 57 /ae
,v),z-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 on property for
in Indiana? Yes El 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.
COUNTYAUDITOR . '
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.
Signature e/ v0 na a Date(month,day,year)
Q/, G/2/76
�( Full�- •ent d1 dress of ap li t(number an street,city,state,and ZIP code) '� 16e y
l` --es-z E- rO0 rtY+'. /// -,vr.� (/
Person 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.