HomeMy WebLinkAboutMortgage_Smith STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ref. '`rJ FOR DEDUCTION FROM ASSESSED VALUATION r
State Form 43709(R13/10-15) t
S ∎ Prescribed by Department of Local Government Finance E DJ
INSTRUCTIONS: File Mark
TO be filed in person or by mail.
JUL 20 4Oifid 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 the county where the prope e s • Co • Auditor
located on or before Jan 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of e.•i 444t x�r�rar County Recorder
where the property is boated during the twelve(12)months before Mad,31 of each year the dpi{; : •' .'l.! 'N • •
Sere reverse side for additional instructions and qualifications.
Mika (owner or contract see restrictions on reverse side)
Taxing District Key number/legal description Record number Page number
�� . /') _ o/- Cf 03 - coo . ( V(o- oA 03 `(5105
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application TT legal or equitable owner?
3 ?), ooV ❑ Yes ❑ No
If no,what is his 1 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 ❑ AnnuaffyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ^
Address of mortgagee or contract seller(nut/mbeber and streeett.Jcity,state,a and ZIP code)
Name of assignee or other owner or holder of mortgage
s•fyilnA LISA
Address of assi gnee(number and street city,state,and ZIP code)
QT 5 / -3 —/ . 89 A c
Does applicant awn property in any It yes,what county? What Taxing District? Has this di 63-1/565
n
i�a an? ❑Yes No currren�t ye
A person is not entitled to this deduction unless the person has a balance on the person's mortgag mty
recorder's office(including any home equity line of credit that is recorded in the county recorder's e
COUNTY AUDITOR
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.
" (owners hit e) Date(month,day,year)
yJ/ un resident address of applicant(number and street,aty,state,and ZIP code)
4A _,9og,/, p t (_L St &ensui Il e 174 ?W,C
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$10,000.