HomeMy WebLinkAboutMortgage_Jones (8) „.> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e'`fib FOR DEDUCTION FROM ASSESSED VALUATION
s. �' State Form 43709(R13/10-15) T T'I �,
Presa Fin
tbed by Department of Local Government Finance
INSTRUCTIONS: File Mark
lb be filed in person or by mail 1!UN 27 201 onnfiledwith:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be hied or posbnadced with the County Auditor or County Recorder of the county where the pro rty is ❑ 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 o County Recorder
where t h e p r o p e r t y i s l o c a t e d d u r i n g t h e twelve(12)m o n t h s b e f o r e M a r c h 31 of each y e a r tleMgaggp �OJ 102 ( AUDI I U R
See reverse side for additional instructions and qualifications.
- owner or contrail buyer-see re 'on5 on reverse s'
40 ill / Cie
T...r•7.'.• Key mrrr /legal descni Record number Page number
T.
, - a e - A 3-/6 -/o o - 0 0 1. n1 60 - 0 x y 40/6 0t.wcL
• ->>•value of real property as of Mortgage I Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
- — - date,ainerd year assessment dash,current year date of appli legal or equitable owner?
ca•”E
? oo o 0 ❑ 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
❑ Real Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
ETFz6(
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 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. -
COUNTY AUDITOR
Der _________
-O P GALJ)J- Q-%l4 20 20 20 20
Sic I to— ,e' 1 I If/J'1~\'Lk County ,Date(month,day,year)
ve and foregoing information is true and correct and that the applicant is a resident of Indiana and
j y on date application is filed.
X S
S . Date(month,day,year)
�r���,/ i s - -
Full resident address of app t(number and mty state.and ZI e)
� i � 3 Y�! ��z 7�� � 'i nc a
Person authorized by duly executed Power of Attorney or by IC e-11-12-0.7 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$10,000. .