HomeMy WebLinkAboutMortgage_Hurt % STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.s FOR DEDUCTION FROM ASSESSED VALUATION
�' State Fomn 43709(R131 10-15)
Ste.I Firesatbed by Department of Local Government Finance
INSTRUCTIONS: jihi a
To be filed in person or by mail. (Form "wit.
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 Auditor or County Recorder of the county where the properly is CC 5J efflir 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 county
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is so .4 it♦•.�
See reverse side for additional instructions and qualifications. 7�f j j�
y/1�1 1H1 GIBBON COON I Y AUDITOR Ltd
51ant(ot er or contract buyer see revert, I r • 1 1
Taxing District Key number/jai description Record r Page number
G-�a-o6-Y - DO4 . 3is- oa8 1 Yes
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 data current year
assessnn I Q da�current year date of application legal or equitable owner?
Ut ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,inchoate with whom
If name on record is durecent than that of applicant indicate below- Is the property in question:Annually Assessed
❑Real Property ❑ AnnuallyAssessed
Mobile Hoare(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and sheet city,state,and ZIP code)
Does applicant own property in any If yes,what county? 'i what Taxing District? I Has this deduction been requested If yes,state amount of deduction
other county - - _- or
in Indiana? ❑Yes ❑No •m— �� Yn, ? ❑Yes ❑No
A person is not entitled to this deduction r if�' yr contract indebtedness that is recorded in the county
recorder's office(including any home equ '`t'(' ce)that is the basis for the deduction.
Deduction approved in the amount of .............
D1'aN'�1' �O•••p�
20 20 ' F�JO ...... _ 20 20
�ca,-rc�d NO. ...............
Signature of County Auditor J�""`an Arai-1 Ec )n Date(month,day,year)
I 1 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 tiled.
Signature( me) Date(month,day,yea)
un J
Full resident address of applicant(number and street,city,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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 haff years and a fine not to exceed$10,000.
•