HomeMy WebLinkAboutMortgage_Hayes (7) ltx STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township Year
e--f' FOR DEDUCTION FROM ASSESSED VALUATION
:,
' .' State Form 43709(R13/10-15)
Presarbed by Department of Local Government Finance S� ZU�6
INSTRUCTIONS: ? 3O File Mark
lb be filed in person or by ma. Form filed with:
Filing Dates: 11 Must��ed Must lweithhtthe County Auditor or calendar
Couunnty Recorder of the county deduction es- .ugbl ��jji p11 OWCounry Auditor
located on or before January 5 of the immediately succeeding calendar year. �.,.1 “0.1. �V ❑ County Recorder
2) Mobile 1 Manufeaured Homes not assessed as Real Properly:Must file with the Courrit�(( p1ioM7Me county
where Ure property is located during the twelve(12)months before March 31 of earn dtTe deduction is sought - - - - -
I legal description Record(/�/' Record number Page number
/191601-( I o(] ? -/Ss-/Oa rn ()3- o aS- aai� 3a8'tf
Assessed value of real property as of IIMortgage/Contract indebtedness unpaid as of Mortgage I Contract Indebtedness unpaid as of Is the applicant the sole
assessment date,current year I assessme t date,current year date of application legal or equitable owner?
f? 70Dd ❑ Yes El No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
K name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Ramiro/mortgagee or tract sefler
Address of mortgagee or contract seller(number and street cry,state,and ZIP code)
Name of assignee or other owner or holder of mortgage /((\�” \/1 /l O
Address of assignee(number and street city.state,and DP code) {✓Y-'15-1 L9
Drawer NO �////\ ) Q
Does applicant own property in any If yes,what county? What Taxing District? H ' on
other aa ❑InIndan Yes 0 N a 1
A person is not entitled to this deduction unless the person has a balance on the person's r Card 1 O. .`-�-•+�•.• 7unty
reaxders office(iincluding any home equity line of credit that is recorded in the county ma
COUNTY AUDITOR'
Deduction approved in the amount of
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
owner/contract buyer of the aforementioned property on date application is filed. q /
Full resident...fl— of appfsant(nu d street carte,and ZIP e)
Person authorized by duly ended Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet 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.
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