HomeMy WebLinkAboutMortgage_Dugan a: OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_11 FOR DEDUCTION FROM ASSESSED VALUATION �IL, F 0
State Form 43709(R13/10-15)
Presorted by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. NO fi!R',, :
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 CountyAuditot-or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediatey succeeding calendar year '. ' e itnirM, ty Recorder
2) Mobde/Manufactured Homes not assessed as Real Properly:Must file with the CountyAuditor of rtatSpn j C ii where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought • I •
See reverse for additional instructions a .qualifications.(/�/ O
Ap • nt mantra bu�er-see i eves ) 04 A �-
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T "����CCCC •=t�� /legal desaip Record number Pae�umber gsif
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
ni 660 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is deferent than that of appliant,indicate belwr. Is the property in question:Annually Assessed
'Real Property ❑ Annually Assessed
Mobile Home(IC 6-1A-7)
Name of mortgagee or contact seller
Address of mortgagee or contract seller(nun? street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) (t.‘.-
Does appC --^ cdv in any if yes.what county? What Taxing District? thhiiseddeeduction been req,v+'ed If yes,state amount of dad cour
in Indiana' Q 1 �W __ ere yran ❑Yes ❑No
A person VJet' N.- e eJ„ Frat„ glance on the person's mortgage or contract indebtedness that is recorded in the county
recorder: "�(y corded in the county recorder's office)that is the basis for the deduction.
`J vN- 6 �I +`d F�I COUNTY AUDITOR
ero
Deductic S.-\Iiv.53 `3c...AA*.
20 aO 1 L-- (IS
Li t S a o o o ,0,i 20 20 20 zo
Signature of County nu...-..
u.... i _I Ca 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
4,3 owner I contract buyer of the aforementioned property on date application is filed.
��``I'' Sig, re owner's Ml name) Date(month,day,year)
Full resident address of applicant( bet and street,dry,state,and ZIP code)
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Person authorized by duty executed Power of Attorney or by IC 6-11-12-0.7 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 half years and a fine not to exceed$10,000. .