HomeMy WebLinkAboutMortgage_Masters (5) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
frG" ' FOR DEDUCTION FROM ASSESSED VALUATION
Stale Form 43709(R13/10-15)
Prescribed by Department of Local Government Fnance
INSTRUCTIONS: ile M i 4)
To be filed in person or by mail. Form .
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 Aur6tor or County Recorder of the county where the property AUG 2 2HO�unry Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cou�7•
where the property is located during the twelve(12)months before March 31 of each year the deduction is a n!�r • en,
See reverse side for additional instructions and qualifications. +r' `aiii
erorcontract G1AS0� COUIYI Y AUDIT
-see ra. it on , . ll L 0 R
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WAL, Ke y mr ilag escnpton ReCOrtl number Page number
4- £ 07. -A,/7-/aV— 00/ 7//- oil2 dot 3 & 76
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract in ebtedn unpaid as of Is the appli ant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
❑ Yes ❑ No
If it,what is his I her erect 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. -ttea uafrAssessed
7)
Name of mortgagee or contract seller
3 `/j Drawer NO. d/
...........(
Address of mortgagee or contract seller(number- ..street,city,state,and ZIP code)
Card NO. .... <9� —
Name of assignee or other owner or holder of mortgage .......,
Address of assignee(number and street,city,state,and ZIP code) ar-
/7-a _/c) .4 e,
Does applicant own property in any If yes,vital county? What Taxing District? Has this.:.uction been requested If yes,state amount of deduction
other county cure�a ❑imIMiana ❑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(including any home equity line 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
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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
/r 1,l owner/contract buyer of the aforementioned property on date application is filed.
Si&&'t(owner's his name) Date(month,day,year)
i A .. ?-22- I(o
sappfxant(number and et,city state,and ZIP code)
I I amp 5 ,E o hi o si I--t wc.,e /0,0 r4,-) 4767 o
Person authorized by duly executed Power of Attorney or by IC e-1.1-12.0.7 Date(month,day.year)
Address of authorized person (number and sheet thy,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.