HomeMy WebLinkAboutMortgage_Maurer (4) r3* STATEMENT OF MORTGAGE OR CONTRACT I t iNE unity Township Year
FOR DEDUCTION FROM ASSESSED VALUATI0111111 �1...,
State Fomr 43709(R13/10-15)
Prescribed by Department of Local Government Finance S E P 2 201
INSTRUCTIONS: File Mark
To 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 whi ught
Must be filed or postmarked with the County Auditor or County H19 lyhp(y(hpp$$terty is ❑ County Auditor
located on or before January 5 of the immediatety succeeding ca a year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before Marsh 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract -see on reverse side) /y�
Taxing istrit2 �/legal description � -Co Record
GJr//�r Page number
/ -� 9 `3/-3t5 9 _2f �
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole •
assessment date,current year r date of application legal or equitable owner?
�!/ C"`� ❑ 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 afferent than that of applicant,indicate belay. Is the property in question:Annually Assessed
T�12eal Property ❑ Annualy Assessed
T Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller iT/
Address of mortgagee or contract seller(number and street,city,state,and LP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street aim state,and ZIP code)
•
Does applicant own property in any If yes,what county? requested If yes,state amount of deduction
other county
in Indiana? ❑
da Yes ❑No oC/0 El No
Aperson is not entitled to this deduction unless the pi Drawer N O 4 :indebtedness that is recorded in the county
recorder's office(including any home equity fine of cn the basis for the deduction.
Deduction approved in the amount of Card NO. 3 (e3
3.
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.
Signature ) Date(month,day,Year)
Fur) of number d street city,stare,and ZIP code)
authorized by duly maned 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 per)ury can include imprisonment up to two and a haff years and a fine not to exceed$10,000.