Mortgage_Overton e*t% STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
State Fonn 43709(R13/10-15)% Prescribed by Department of Local Government Finance
I
FiL
NSTRUCTIONS:
i
To be tiled in person or by mail.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. -F o nn with:
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prop, 4 f4 4 20 County Auditor
located on or before January 5 of the immediately succeeding calendar year `"''
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county I County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduct,o t sought4 .—
See reverse side for additional instructions and qualifications. I' • 's" u
Applicant wnerorcontract buyer-see restrictions on reverse side) (aBSON COUNTY AUDITOR
4 r0 4 e Q 4 ex I'1 , 1`
Taxing District Key number/legal description V1(J I o�.,tib ,/'1 co -7-7�.+ I ry
I 1"t a R bpr P number_
Assessed value of real l p—k -I _ 3v4 -lxx,_ '4 LP 0_02 Lp I (,Q u ..
property as of I Mortgage/Contract indebtedness unpaid as of I(rMortgage/Contract indebtedness unpaid as of Is the apn�sole
assessment date,current year assessment date.current year date of application legal or,equitable owner?
If no.what is his/her exact share of interest? W ,I dry, Rids ❑ No
If owned with someone other an spouse.indicate with whom
If name on record is different than that of applicant,indicate below.. (f
Is the pr party in question:Annually Assessed
eat Property ❑ Annually Assessed
Na of mortgagee or contract seller Mobile Home(IC 6-1.1-7)
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,city.state.and ZIP code)
Does applicant own property in a If yes.what county? Wbat Taxing District?
other county 9 Has this deduction been requested If yes,state amount of deduction
in Indiana? Yes No on property for
❑
current year?
El 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 I 20 I 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/ ract buyer th fore entioned p party on date application is filed.
Suture w r � ( �f/ Date(month.tlayyear)
Full resi ddress of a �n number and street,cif state,and ZIP code) r 5-10? /
7b/ P Lo S+ cb f')J-r h r-+- Aro A(?) `-/7Lthe
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-al 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.