HomeMy WebLinkAboutMortgage_Hunt (11) x> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE y ,i Township Year
ct.t=ftn FOR DEDUCTION FROM ASSESSED VALUATION �` �'
State Fonn 43709(R13/10-15) g,
Prescribed by Department of Local Government Finance ,Cp16
INSTRUCTIONS: WC) 3 File Mark
lb 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 i •.ugh_! ';
Must be filed or postmarked with the County Auditor or County Recorder of the county
r.4!!!R:isiorT County Auditor
Po city N mY " i.u, • ..: r
located on or before January 5 of the immediately succeeding calendar year. COUNT County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cpfyl3P for of the county
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.
Appfiant(owner or conpagbuyer-seefpsblcVonss gp re FJJ rse side) G/7y, /y
•Cf./ALL�{J_!X/7Q Ke �/ r/l a �� `�Z�"`"!
Taxis District Key number!legal d Record number Page number
�1 ) ab- /a -Lg. -all / 7/6 0a V /to / 77v
Assessed value of real property as of Mortgage I 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 legal or equitable owner?
,S7 4AOC) ❑ Yes ❑ No
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If nacre on record is different than that of applicant indicate below: Is the property in question:Annually Assessed
Zeal Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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,qty,state,and ZIP code) ��^T7 (/(J�
Does applicant own property in any If yes,what county? Mat Taxing District'? Has this dart V f `——O S ^_�� —
other county on property I `�
in Indiana? ❑Yes ❑No current year /
A person is not entitled to this deduction unless the person has a balance on the person's mortgage Drawer 1\r
recorder's office(including any home equity fine of aedit that is recorded in the county recorder's of �'''
COUNTY AUDITOR I 1 _
Deduc�n approved In the amount of. Card j�r O. I O
............
20 20 20 20 20 20 20 ---
Signature of County Auditor County • Data(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.
Signature �-5 tP/ n f . /� Date(month,day,yea,)
AI em adtlreg of appri n Zd aty,state,and ZIP code)
Y S20 ,s. ce S 1)-rncc_rfrt., /ir 2-L7/. 7n
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. .