HomeMy WebLinkAboutMortgage_Kissel (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
irl. FOR DEDUCTION FROM ASSESSED VALUATION .
State Forth 43709(R13/10-15)
Presented by Department of Local Government Finance FIT ,E, D
-Rlettain
INSTRUCTIONS:
To be filed in person or by mad. •�q�n y}.
Fifmg Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction Is sought. DE. G 1 L�ID
Must be hied 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 Properly.Must file with the CormtyAuditor of the county a
the `/'(, v rder
where e property is located during the twelve(12)months before March each 31 of ea year the deduction is fj•la'
See reverse side for additonal instructions and qualifications. GIBS ON COUNTY AUDITOR
Applicant(owner 0. . a ICM
Taxing District Key number I legal description number Page number
%- 11-a5- �1oo -000. 5A8-O '? I 51•
Assessed value al real property as of Mortgage/Contract indebtedness unpaid as of • Mortgage/Contact indebtedness unpaid as of Is the app&mrrd the sole
assessment date.currant year assessment darid year date of application legal or equitable owner?
/S 0� ❑ Yes ❑ No
If no,what is his/her enact share of interest? If caned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate bel oar. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contact seller(mmnbeia,d street,city,stale,and ZIP code)
Name of assignee or other owner or holder of mortgage •
•
Address of assignee(number and sheet City stile,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
on Property for
uxfiarha7 ❑yes ❑No aarentyear? ❑Yes 0 N ,
A person is not entitled to this deduction unless the person has a balance on the person's ma(gage or contact indebtedness that is recorded in the county
1 recorder's office(Indudmg any home evilly fine oferedt 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
Sigrrahrte of CountyAudda 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.
(ewrars a Date(month,day,year)
Flu' ent address of applicant(number city,state,and ZIP code)
Person authorized by duly executed Power of Money or by IC 61.1-12-117 Data(month,day,year)
Address of authorized person (number and street o1}:state,and ZIP code) u•
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.