HomeMy WebLinkAboutMortgage_Schafer (3) �- a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court i Year
AV FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
�- Prescribed by Department of Local Government Finance •
INSTRUCTIONS: D E Eil€18'$016
Ta be filed in person or by mail. Form filed 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 with the County Auditor or County Recorder of the county where the properly is./lG... n Auditor
boated on or before January 5 of the immediately succeeding calendar year. q�Rc!]1 COCI ' '1�Qrder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of rife county
where the property is boated during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant owner or conrrayt buyer-see restrictions on reverse side)
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owneR
;of/ ys0 ❑ yes 0 N
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 below: Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(number and street,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? Wnat Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes El No current 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(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
a0 1�� 5�, $ - -- :OUNTY AUDITOR
Deduction ap U
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20_ I 20 20 20 20
Signature of C�� e'er County • Date(month,day,year)
I/We a oing information is true and correct and that the applicant is a resident of Indiana and
I a,
5- olication is filed.
krai re(owner's full name) Date(month,day,year)ber anc4eet,4 0,411 h., 14, 0 CT T X F a 9 17 I u /L o-le- state. • • 'code) /�z C,--- / y (o-7-6
Person 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 LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .