HomeMy WebLinkAboutMortgage_Carr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou dacha allitear
'''. FOR DEDUCTION FROM ASSESSED VALUATION iP/
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State Form 43709(R13/10-15)
'---L- Presahed by Department of local Government Finance
2016
INSTRUCTIONS: Une Mac
T)be filed in person or by mail. Fonn filed •h:
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orpostmariced with the County Auditor or County Recorder of the county where the properly is Nr'` Y Auditor
located on or before January 5 of the immediately succeeding calendar year. GIBSON COST&E /IQrlaer
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 sought
See reverse side for additional instructions and qualifications.
Apparent(owner or contra buyer-see restrictions on reve side)
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Taxing District ) Key number/legal description U Record number Page number
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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,current year assessment data current year date of application legal or unable owner?
50")).5,c) Yes ID No
If no,what is his 1 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 belaw
kp property to Question:Annually Assessed
sal Property ❑-^/ lyAssessed
' i tome(IC 6-1.1-7)
Name of mo !-!ee or conted seller
Ihill rat seit . ✓til I It= 1 - O. .
Add-..of a„ .or..4.. seller( ..berandstrmet,city,state,and LP code) C�1h✓
Name of assignee or otter owner or holder of mortgage - T`J V1
Address of assignee(number and sheet city state,and ZIP code) 1.'
Does applicant own property in any If yes,what county? What Taxing District? V` -
Does county ty1 vdng ` 0• •• ,es,state amount of deduction
in Indiana? ❑Yes IS* l a (]` _no
A parson is not entitled to this deduction unless the person has a balance on the person's m. (2' ..indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county cocoa). ...at is the basis for the deduction
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Aoditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. ,
Signature( e) Date(month,day,year)'
Full dress of applicant(number and sheet,city,state,and ZIP code)
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.r/ Dale(month,day,year)
Address of authorized person (number and street city,slate,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. .