HomeMy WebLinkAboutMortgage_Snyder (2) s. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
F - .`" FOR DEDUCTION FROM ASSESSED VALUATION p
°r:. '. State Form 43709(R13/10-15) ��
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
i rk
Tb 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 is sou iltP 8 2016
Must be filed or postmarked with the County Auditor or County Recorder of the county where the •roperty is ❑ County 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 Counmty'Audito a�.i:= ,e4p�fllai
where the property is located during the twelve(12)months before March 31 of each yetsi>B�®pyu�y i. :4!(i,See reverse side for additional instructions and qualifications. AUDI TOR
Apple (owner n contact buyer restrictions on reverse siiddde)Q` 'i',',^� �Aid qi
Tasting�District JC.� Key number/legal .' " / Record number Page number
YYY x o/— /DJ —coy, 6 69_ 0 l / aoi6, .3 37
Assessed ., _J. real p••- •j of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment• wnent y-=/ assessment date,current year date of application legal or equitable owner?
/& 0 r 0 Co 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. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1A-7)
Name of mortgagee or contract seller / . �V�{7-f
contact Address of mortgagee or contr seller(number and and state,and ZIP
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? What Taxing District? Has this deduction been requested If yes,state amount of deduction
Inn'�ndiaanna? ❑Yes ❑No , on 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.
20 20 20 20 20 20 20
Signature of County Auditor County Data(month,day,year)
•
I!We rtify 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 e aforementioned property on date application is filed.
`,Sig % i l• morn ) / Date(month,day.year)
JC` residaq/• of t l,(/X/an/dd sheet,city,state,a ZIP code)
X (0-1 • e ?SA' 4J ) er l n( �reekTDrtve OWe 3Vi tle lI\ 4-1C�b5
Person authorized by duly executed Power of or by C 1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city state.and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10,000.