HomeMy WebLinkAboutMortgage_Turpin (7) ,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.t• FOR DEDUCTION FROM ASSESSED VALUATION I IState Fonn 43709(R13110-15)
Presed by Department of Local Govemment Finance L F
•
INSTRUCTIONS: FileMark
To be filed in person or by mail. DEC 11,10 p :
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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cou tmty"Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduattiMO rOU V TY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see res4ther. verse side)-
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Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole •
assessment dap, assessment date,current year date of7plfin legal or equitable owner?
/QU ❑ Yes ❑ No
If no,what is his/her exact 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 e property in question:Annually Assessed
�Yl Real Property ❑ Annually Assessed
Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller (1 I 62.?
Address of mortgagee or contact seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage /L
Address of assignee(number and sires te,and P code) /1/ /1 ���r/
) a- Q c� G
0
Does applicant own property in any f t county? What T g District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes ❑No cement 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(induding any home equity line 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 I 20 I 20— I 20 20
Signature of County Auditor Date(month,day,year)
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I/We certify under the penalty of perjury that the above: D r a 1 YC P NO...,�O /( I/ 1 applicant is a resident of Indiana and
4, owner I contract buyer of the aforementioned property or
...............
r" Signature( e _ 5-0)`90 I Dap(month,day,year)
`� /�1//%'_ Card 11'O. .......... J
Fyll dress of appfictlh (nu b6-and street,city,state,ar •••• •.••..
i 4'53 Amon. Si-arc bczya 133/066
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 " Date(month day,year)
Address of authorzed 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. - -