HomeMy WebLinkAboutMortgage_Householder STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court • Aka
FOR DEDUCTION FROM ASSESSED VALUATION
Form 43709(RI3I 10-15) • c l `)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: F' `�
12 7 I r
To be filed in person or by mall. - Form fled 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 will the County Auditor or County Recorder of the county where the property is 1' ; -/4,..th'.:'
located on or before January 5 of the immediately succeeding calendar year. GIBSON •n . er
2) Mobile/Manufactured Homes not assessed as Real Properly:Must(Re with the County Auditor of the county • 'i. TOR
where the property is located during the twelve(12)months before Manic 31 of each year the deduction is sought
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See reverse side for additional instructions and qualifications. (� {Q rid /
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Fisbict Key - a o_ �Qi-t�O � —G0- `:eon 76, X108
Assessed vague of Taal properly as of Mortgage/Contract indebtedness unpaid as of • Mortgage I Contract indebtedness unpaid as of Is the appb and the sole
assesmnent date,current year asst date,cement year data of application legal or equdable owner?
❑ Yes ❑ No
If no,Must is his/her exact share of interest? If owned with someone other than coolies,indicate with whom
If name an recent is different than that of applicant,indicate below: Is the ttthe property in question:Annually Assessed
(�Real Property ❑ Ainia Assessed 0-1.1-T)
Nano of mortgagee or n*el
(2-71-f�n ,n
� f-S_l/e /C.J a Vex
Address of mortgagee or extract seder(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage '
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Address of assignee(number and street shy,state,and ZIP code) •
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Does applicant own property in any If yes,what county? • What Taxing District? Has this deduction been requested If yes,state amount of deduction
cenN Yes No current ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contrail indebtedness that is recorded in the county
recorder's office(including any home equty fine 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
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20 20 20 20 20 20 20
Signature of CountyAcMCo Canty 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 1 contract buyer of the aforementioned property on date application is fled.
( ens Date(month,day,year)
Full resident address of applicant(number and sheet,city,state,and ZIP cede)
cgh N. Senhirar St Pr;nce'frr„ Ohl - 447.6 0
Person authorized by duly executed Po*. Attorney or by IC 6-1.1-12-0.7 Date(month,day,yam)
Address of authorized person (number and street all: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.