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HomeMy WebLinkAboutMortgage_Ross x� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year t FOR DEDUCTION FROM ASSESSED VALUATION -_ State Form 43709(R13/10.75) -� Presalbed by Department of Local Government Finance INSTRUCTIONS: File a lb be filed in person or by mail. 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 propei1 qN 7County Auditor located on or before January 5 of the immediately succeeding calendar year. H 6 l rCounty Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county where the property is located during the twelve(12)months before March 31 of each year the deduction is ugh f. See reverse . for additional instructions and qualifications. Applicant(own contract -see �sinde) G SON COUNT AUDITOR (J�� Taring District Key !legal description Record n Page number d - is -o)- 103 - Ooo , a4 ? - © a8 OR Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant ethe sole assessment date,current year assessment date,aurent Year date of application legal or equitable amen 5 1 r152) ❑ Yes ❑ No If no,what is his I ter exact sham of interest? If owned with someone other than spouse,indicate with whom If name on record is different than that of appri ant,indicate belay. Is the property in question:Annually Assessed ❑ Real Property ❑ AnnuallyAssessed h. • Mobile Hone(IC 6-1.1-7) Name of mortgagee orcontract seller/ n J � K Address of mortgagee or contract saner Our ben nd street city,state,and 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? What Taxing District? Has this deduction been requested If yes,state amount of deduction otter county on property for in Indiana? ❑Yes ❑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 tine 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 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/contract buyer of the aforementioned property on date application is filed. Sig re(ou'r(ers hdl name) ^ Date(month,day,yeah F ••i 1t ad`{r/fdresspff alpp1\• tt(n`uu bar and street,city,state,and ZIP code) arson authorizedbyby duly executed Power of Attorney or by IC Gt.t-12-0.7 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.