HomeMy WebLinkAboutMortgage_Hornick STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'r'v- FOR DEDUCTION FROM ASSESSED VALUATION
:7%'• a'^ State Form 43709(R13!
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Presatbed by Department of Local Government Finance aHl ,�+J
INSTRUCTIONS: File Mark
To be filed in person or by mail. rc'CCpp Form filed 99016 Fo filed with:
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for',gel)the de =n is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where :property is i_Mo County Auditor
located on or before January 5 of the immediately succeeding calendar - j ,j County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must = r:cvC..+•uditor of the county
whem the properly is located during the twelve(12)months before - .. • i-a ypztrbtal ion is sought .
See reverse side for additional instructions and qualifications. GIBS
Applicant(owner or contract -see re ' ions on reverse sqe)
Taxing D".it Key number le desaia(�Lpti nn Record number Page number
-'01 &o- 9-i9, /aaaao cog oa Co ao/(o 1
3c...2.
=•value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
/0 37gs ID yes 0 N
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 _ I Is the properly in question:Annually Assessed
r G- -. ."-^°.+v D_AnnuagyAssessed
I�� Cr LLQry,l,l{1 1j'Th q Z-"nC fr1.1-7)
Name of monger ee or contract seller Draw-I. / .3
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Address of mortgagee or contract r(number and street sir,state.and ZIP code) .W'•••.,.
card ro. . 3114
Name of assignee or other owner or holder of mortgage _A 108 7, s ...................
Address of assignee(number end street city,state,and ZIP code) `W
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 on property for
in Indiana? ❑Yes El 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(induding 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 County Audits 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 I contract buyer of the aforementioned property on date application is filed-
Signature fu8 name) Date month,day,year)
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Full of t numberand street city,state and ZIP code) ,� `
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Person authorized by duly executed PPoowwaol of Attorney or by IC 6-1.1-12-0.7 I 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.