HomeMy WebLinkAboutMortgage_Evans (2) '. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r•\'_. FOR DEDUCTION FROM ASSESSED VALUATIOI
--t'" , State Form 43709(R12/6-14)
/ Prescribed by Department of Local Government Finance
INSTRUCTIONS: JUN 1.4 2016 File Mark
To be filed 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 deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of coun h property is �' County Auditor
ca
loted on or before January 5 of the immediately succeeding calendar ye rt l ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:MutillagettatIVAIMOBILIT002county
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 or contract b r)see restrictions on re a side)
'n^ u
'rg is ' Az number/I al description to Record nu ber Page number
O-oq- 5- 1 Da-oOo 31.6--,030 ao l , 023/7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
. CO ❑ Yes ❑ No
If no,what is his I 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
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller •
Address of mortgagee or contract seller(number and street, ,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any I If yes,what county?__- What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county_. -- on property for
in li current year? ❑Yes ❑No
A pt ,(y^ m has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recc Drawer N O.• •• •.• . that is recorded in the county recorder's office)that is the basis for the deduction.
��- —S-1/ COUNTY AUDITOR .
D� Card NO.
- 20 20 20 a� 20
•
Sign I /�(��/��] County Date(month,d lY 1�to
/We the penalty of pe'rjury Mthat-fF1E`36a d 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.
Signaturehowners full name) Date(month,day,year)
r
tiEuljr€sident address of app cant(n r� r ands t,city, tie,and IP code)
x p
ion authoriz-.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. -