HomeMy WebLinkAboutMortgage_Engler }�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
it __' FOR DEDUCTION FROM ASSESSED VALUATION
` State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance �(
INSTRUCTIONS: jFi i; Marry
Tb be filed in person or by mail. FPo�w --'
Feting Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought non
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is AUG 1M Ivry Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
See reverse side for where the prinstructions r y s located and ring the twelve(12)months before March 31 of each year the deduction is so • I
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Applicant(o eror contract buyer-see on rses/de) e GILISON COUNTY AUDITOR
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Taxing D" ma /legal description Record n Page number
9(0 - 11-1 a- /0 Y n. sea -CO 3c7R- I
Assessed value of real property as of Mort gage/Contact Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,amen year assessment dale.aorren year date of application legal or equitable panel
as s DC0 ❑ Yes ❑ 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 efferent than that of appimnt,indicate belay Is the property in question:Annually Assessed
❑ Rea)Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and sheet,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? _— — --n requested If yes,state amount of deduction
other
in Indiana? ❑Yes ❑No m ❑No
A person is not entitled to this deduction unless the) ct indebtedness that is recorded in the county
recorder's office(including any home equity Gne of c D Y a 1Y C r NO 3°1,. , is the basis for the deduction. •
Deduction approved in the amount of Card NO. 2_/LiI....
20 20 2( ff�J`` 7! 20 20
Signature of County Auditor 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(I contract buyer of the aforementioned property on date application is feed.
Sign r(mw�S ru9narm Date(month,day,year)
Full resident of applicant(number and street city state,and ZIP code)
Person authorized by duty executed Power of Attomey or by IC 8-1.1-12-0.7 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. .