HomeMy WebLinkAboutMortgage_Remer �, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
k.`• "'' FOR DEDUCTION FROM ASSESSED VALUATION
co) State Fonn 43709(R13/10-15)
Prescribed by Department of Local Government Finance IF I E I File Mark
INSTRUC77ONS:
lb be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year(q5► nclAtlg d %gt is sought
Must be filed or postmarked with the County Auditor or County Recbff-kbokM c6MrFt�where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must with th ' of the county
where the property is located during the twelve(12)months before the deduction is sought
See reverse side •difional instructions and qualifications. CIRSOPf COL
MTV AIIfITAR
ii
Applicant(owner or.l on reverse side)
T.•, r t.1., Key number/legal descri R nu r Page umber
I- � - °�d �-! - as-aco-ono. t� off° ol� Page
_•vakre•I property of Mortgage 1 Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
assessment dabs,- >,year U assessment d nt r date of application legal or equitatae owner?
❑ 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 belays. Is the property in question:Arm uafyAssessed
. ❑ Real Property ❑ Annually Assessed
/'� Mobile Home(IC 6-1.1-7)
or of mortgagee contract seller aI \
�iv,....,
Address of mortgagee or contract seller(number and abeet 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
n Inddiana? ❑Yes ❑No current year?for ❑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(induding any home equity.line of rrwra than-------'Th county recorder's office)that is the basis for the deduction.
/� f AUDITOR
Deduction approved in I �,} 2(' I( „ /�.� Q
1 J �r .�71 Y....Y....
zo11 ` Drat�cr \O.•••• _ 20 20 20
Signature of,. •tyA • `... O�...... County J�� Date(m dayye J I_
k, Card \O. ........ KJ
I, e certify under we penalty of perjury that the racjiigforegoing 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.
naturey,(-e��yrrer's 1'0nLnaalme) Date(month,day,year)
resident address applicant(number and street city,ate,and ZIP code)
la �s3z C� 4iov S YoSry0ly r1 '/76 3
Person authorized by duty 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 forper)ury can include imprisonment up to two and a half years and a fine not to exceed$10,000.