HomeMy WebLinkAboutMortgage_Allen (7) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS liusityr TTrgTri& Year
,- FOR DEDUCTION FROM ASSESSED VALUATION
r=t 'r State Form 43709(813110-15) ki ii
Na Prescribed by Department of Local Government Finance ,per
INSTRUCTIONS: NOV I".t�Ile[Ulgc
lb be filed in person or by malt. - Form filed with:
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 pmp unty Auditor
located on or before January 5 of the immediately succeeding calendar year. �n�nt��ecerder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County AuditrPMA l$9UNTY 8ffe
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant owner or contract buyer- - -.•- s on reve
Taxing fit, / °^ • lg i 1 403 DOD J&5- 19c2(0 R CQOi number number
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,anent year assessment date,current year dat of app tenet or equitable owner?
l Ra ,s ❑ 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 different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
Mobile Hone(IC 6.1.1-7)
Name of mortgagee or contract seller f� •,t 4.
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 street city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
�iaana? ❑Yes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of Canty 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 I contract buyer of the aforementioned property on date application is filed.
re/(ow/ners tut name) Date(month,day,year)
_�i/yrtrA imo /741/2m..• '7 Q //- 7-zo/6
FA o�St S o1 t( robe �a��e) G 6 -1(J
Person authorized by duly executed Power or by IC e-1.1-12-01 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. _