HomeMy WebLinkAboutMortgage_Bruce (6) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
�— Prescribed by Department of Local Government Finance
INSTRUCTIONS: , lat�1PyA D
lb be filed in person or by mail. rmlittt"'
Filing Oaten 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 Auditor or County Recorder of the county where the property is Cpugy.Audltor
located on or before January 5 of the immediately succeeding calendar year. • C o Lc Uu�t Uo
County Recorder
2) Mobile I 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 March 31 of each year the deduction is sought /)I
See reverse side for additional instructions and qualifications.
Applicant( or ctbuyer-see 'dionson reverse side) ('IbSON COUNTY AUDITOR
Taxing El number thump. '400 -001 . 330-006 Record number Page
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,au ent year assessment dati date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
tf name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ AnnualyAssessed
Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
r-
Address of mortgagee or contract seller(number and street ary,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage
Drawer NO
Address of assignee(number and street d4:slate,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has Card jN O. 6
n
in Indiana? ❑Yes ❑No curtest year? t_, •
••.••••••'•-.
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is feast.,,.-___ 'unty
recorder's office(inducting 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 ot.
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,yew)
I/We certify under the penalty of perjury that the above and foregoing infonnation 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 re owner's fug e) /} Date(month,day,yea)
MSLCL l/ '
Full rent address applicant(number and std,dty, and LAMP e)
Person authorized by duly executed Power of Attorney or by IC 6-11-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,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.