HomeMy WebLinkAboutMortgage_Graham .a-. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year•!t' =' FOR DEDUCTION FROM ASSESSED VALUATION
.,--ic, .�. State Form 43709(R13/10-15)
S 4" Prescribed by Department of Local Government Finance
FILE
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought OCT 3 1 is 1R ry
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is l.`1'_.bun Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ unry Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cou
where the property is located during the twelve(12)months before March 31 of each year the deduction is
See reve 'de for additional inshuctons
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Ty. / Record number Pag mber
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• .. =•value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
•7 - dad,current year assessment date,current year date of appOCatnn legal or
�f Odd equitable 0 N
❑ Yes ❑ No
If no,what is his!her exact share of interest? If owned with someone other than spouse,indicate with whom
If nano on record is different than that of applicant,indicate below Is th operty in question:Annually Assessed
' Real Property ❑ AnnualyAssessed
/ / ,{' ` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /
�ior /It
Address of mortgagee or contract seller nu and street city,state,and ZIP—•-
Name of assignee or other owner or holder of mortgage
6
Address of assignee(number and street,city,state,and ZIP code)
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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 Into 1=1.vac ❑No current year? ❑Yes ❑No
�_.___
A per; • +r+has a balance on the person's mortgage or contract indebtedness that is recorded in the county
rers 4 7 7)71 r5 O,5 ?corded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deal Drawer NO.. c2011-0
-! ' Cal'd����•...... 3 20 20 20 20
Signature of County,.,, QING tQr(IN• •• 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.
Si re(owner's hill name) Date(month,day,yea)
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Fug address of applicant(number and SOCA city,state,aid and ZIP code) -
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Person authorized by duty executed Power of Attomeyor by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street thy,state,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000. .