HomeMy WebLinkAboutMortgage_Maglis s, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION /
State Form 43709(Rl3/10-15)
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e) Presorted by Department of Local Government Finance I-4 1
INSTRUCTIONS: AUG File Mark
)b�fFliled
7b be filed in person or by mail. Flbttl 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 propertyQ- . ■ A. ' '- Auditor
located on or before January 5 of the immediately succeeding calendar year. it • gTwl�i ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County AUditoreneS nt UN TY AUDITOR
each where the property is located during the twelve(12)months before March 31 of ea year the deduction is sought
See reverse side for additional instructions and qualifications.
ar or contract rse side)
T- r Key nu /legal desai 7 1 num Page number
dCl2 Jo& OCl7. 7 -O� ? /C 9'537
of real property as of Mortgage I Con indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
- — -nt date,current year assessment date,current year date of application - legal or equitable owner?
/// ❑ Yes ❑ No
It 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 roperty in question:Annually Assessed
eel Property ❑ Annually Assessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seller , / �� `1
Address of mortgagee or coitus*seller(number and btrdeL city state,and ZIP code)
Name of assignee or other comer or holder of mortgage
o/ /3
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing 0 ' . Has this deduction been requested If yes,state amount of deduction
other on property for
In Indiana? Yes ❑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 linrehenn any h^ma ansau line^r^,^.G1 n.^.:^.---bled in the county recorder's office)that is the basis for the deduction.
Deduction appro
en AgL- j 7R ACy G COUNTY AUDITOR
JAM E5 M
20_ 20 20 20 20
Signature of Col / 1 —0i 53 ! County Date(month,day,year)
I f We certify,..n.a. u,a validity ui penury mat me aoove arta foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
itPinature(owner's name)a. 4,Q �'/� Date(month,day,year)
Ft)!t'residem adtlreu�oi (nun arN state.ard�LPFode #1620
t,/l✓ !/ t,6 IC/Y-1t 12-0,.7
Person authorized by duly executed Power of Attorney or by IC&1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and street city state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .