HomeMy WebLinkAboutMortgage_Angle (4) •'"c STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
"f' State Form 43709(R12/6-14)
\ r— Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail.
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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 prope is ,II r ditor
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 CountyAuditor of the county.InN 0 2016
where the property is located during the twelve(12)months before March 31 of each year the deduction is sou
See reverse side for a.-''.nal instructions and qualifications.
Applicant(owner or•.fit uyer;see rests • s n reef side) 7 (
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Taxing District Key nu r I al desaiptio r age D I
6 -I - la. .303 -000. 4Litada III )q5
Assessed value of real property as of ortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,• , v==r 071D date of application 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 different than that of applicant,indicate below. Is the property in question:Annually Ac sled
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ,..( u
`
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage _
Address of assignee(number and street,sty,state,and ZIP a R ry//,-(,�Does applicant own property in any If yes,what county? fe�(a.PJD 1 �—` d If yes,state amount of deduction
other county I in Indiana? ❑Yes ❑No /y� 'o
A person is not entitled to this deduction unless the persc 1 OZW dness that is recorded in the county
recorder's office(including any home equity line of credit; V 'y y#( ( .2 r s for the deduction.
Deduction approved in the amount of: (•-�J�I 1 �/
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 uyer of the aforementioned property on date application is filed.
Sigrratyfe(owner am ) , Date(month,day,year)
Full fes lens ad r prima f-rr•- an, f .city,state,are5 code r1 q 2 _
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. •