HomeMy WebLinkAboutMortgage_Cutsinger s ., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
• r FOR DEDUCTION FROM ASSESSED VALUATION
_.: if, State Form 43709(R13/10-15) -. FILE
S` "! Presatbed by Department of Local Government Finance
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INSTRUCTIONS: Fie Mark
To be fled in person or by marl Eto with:
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought. N 9
Must be filed orposbnarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor ;
located on or before January 5 of the immediately succeeding calendar year. J
2) Mobile/Manufachaed Homes not assessed as Real Property.Must file mill the County Auditor of the co
�laslp/k Recorder
where the property is located during the twelve(12)months before March 31 of each year the dedgr,'ggaEptiitUN1 Ni AUDITOR
See reverse side for additional instructions and qualifications.
Applicant erercontract uy -see " ' on reverse sldv) / .
T strict keY / Record number Page number
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Assessed value of mal property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the appirant the sole
assessment data,current year assessment dare,and year date of application legal or equitable owner?
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If no,what is his I her exact share of interest? If awned with someone other than DOD ❑ Yes ❑ No
Space,indicate with whom
•
If name on record is different than that of?petard,indicate below: ——I.Lc the nn..nm.In.nw<m nt AnnsSr Accacsa1
Nark of mortgagee or contract cater
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Address of mortgagee or contract seller(manberand street,city,state,and ZIP code) H 14,x`S*o.M ` q-It e (Qr�°'v�
Named assignee or other wmeror holder d mortgage ' - "l( I()p O ao �b – 'Y J ). i
•of assiorren(number and street:cfv state.and code) ( \o - ��- l`o
Does applcant own property in any If yes,what county? - What Taxing District? Has this deduction been requested Oyes,state amount of deduction
other county in Mane? ❑Yes ❑No Ion ament ? ❑Yes ❑No
A person is not entlted 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 fine of credit that is recorded in the county recorder's 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 County Auditor County Date(month,day,year)
I 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!contact buyer of the�afoor�ementioned property on date application is filed.
ktufreee) Data(month,day.year)
/jai( /
ent �applcant(number�id steer city,state,and ZIP e) \
Pelson 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 half years and a fine not to exceed$10,000.