HomeMy WebLinkAboutMortgage_Hudson (3) Township STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Townshi Year
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FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
.: Prescribed by Department of Local Government Finance IL
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is 2
Must be filed or postmarked with the County Auditor or County Recorder of the county where the perty is U County Auditor
located on or before January 5 of the immediately succeeding calendar year:
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor oft ll.- cot. t _„ii, County Recorder
where the properly is located ted during the twelve(12)months before March 31 of each year the did t,, =•:•G1: A ii -
See Applicant rse ��2Myer see "/A qualifications. r,18SON GOO
aor contract Key number Taxing D
/o number �
° Q y S . voce 670058-6 S8' 5 Qad ao/ (Q c3 65R
Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cement year (assessment date,current year date of application legal or equitable owner?
/3 FA/0° ❑ 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 different than that of applicant,indicate below. Wroperty in question:Annually Assessed
al Property ❑ Annually Assessed
• Mobile Horne(IC 6-7.1-7)
Name of mortgagee or contract salter ,.r / , a , I
Address of mortgagee or contract seller`(rumba and street city state,and ZIP code)
Name of assignee or other owner or holder of 8 u•t1age
Address of assignee(number and street,oily,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county , for
in Indiana? Yes [1]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
recorders office(including any home equity fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of.
20 20 20 20 20 20 20
Signature of CountyAuditor 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.
Sig (owna5(IX name) iik or Date U•N.•dr,day,year)it •
` X4 Al A la _ALA 1I •its.. 2i_I. IA at. Al 0 _.a
Full •-t address of app Ir (number and sheet oi) Sate. •ZIP code) I
Person authorized by duty executed Power of Attorney or by IC 6-11-12-0.7 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.