HomeMy WebLinkAboutMortgage_Cartwright STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County IrahiE D Year
FOR DEDUCTION FROM ASSESSED VALUATION
., r State Form 43709(R13/10.15)
<- Presrnbed by Department of Local Government Finance
INSTRUCTIONS: . JH ; Ma '
To be filed in person or by mail Form filed
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 / • Mr CA-4• 1 •for
located on or before January 5 of the immediately succeeding calendar year. ii
r�t�ornc�.�' �• Y.A ty Record a , err
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of ftlCwa/ayr• C• � y A � �
where the property is located during the twehe(12)months before Mardi 31 of each year the deduction is sought
See m ,,r��_side for additional instructions and quaff . S. W N"^"er r con6at buyer '_- ;•� on - - •:side) �Q�
D" W // Key number/ _•- descri / Record number Page number
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole •
assessment des,aurent(e assessment date,current year date of application �1 legal or equitable owner?
X313dD
° ❑ Yes ❑ No
u no,what is his I her exact share of mterest7 If owned with someone other manspouse.indicate with whom
If name on record is different than that of applicant,indicate belay. Is the properly in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract -i�!'�= and street city, -. -.and ZIP code) M - _ k L �
Name of assignee or other owner or holder of mortgage J i t �` r� 1
Address of assignee(number and street city,state,and ZIP code)
10-59
Does applicant own property in any If yes,what county? Mat Taxing District? F ,
other county ,
in Indiana? Yes ❑No current year/ u ,w _
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 me wanly
recorder's office(including any home equity fine of credit that is married in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount at
20_ 20 20 20 20 20_ 20
Signature of County Auditor 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 1 contract buyer of the aforementioned property on date application is filed.
.1\ Signature fun Date(month,day,year)
Full resident address of applicant(number and street,city.state,and ZIP code)
nit s, zso ev%.,/r rn-) sn/ X7670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12a7 f Date(month,day,year)
Address of authorized 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. -- -_ - -. -- .