HomeMy WebLinkAboutMortgage_Simms ..4-. ..,... ... STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County . so ship Year
Gy '�=-kqA. FOR DEDUCTION FROM ASSESSED VALUATION ! f ]j ; y �p
_-`°re State Form 43709(R13/10-15) �' �1
`7.- i by Department of Local Government Finance
INSTRUCTIONS: 6'r: 1.1 I •
To be filed in person or by mail. Form filed " .
Filing Dates.' 1) Real Properly 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 , E r•u.•: _ •-' •r
located on or before January 5 of the immediately succeeding calendar r��A�inn 1r•
2) Mobile/Manufactured Homes not assessed as Rea/Properly:Must file with the County Auditor of the NW N •0�v�••.A• DlT. •
where the property is located during the bvehre(12)months before March 31 of each year the deduction is sought DIT
See reverse side for additional instructions and qualifications.
Appr t er or V see -••"•••••.^on reve ) -1 4
T J. 'r umber/ ptron Record number Page n ter
i+ +` ,a)c, I/rte- - earb.60a. a - Da7V 1 8
• -- =•value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant sole
, - t date,current year assessment date,current year date of application O legal or equitable owner?(� ❑ Yes ❑ No
If rio,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}�property in question:Annually Assessed
Real Property ❑ Annually Assessed
\/l Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller (ea,/,27, 8
Address of mortgagee or contact seller(number and street city,state,,and ZIP mode) 71
Name of assignee or other• •Ater• -e age �, ^ U
Wei,/ 0? VOLAtittO Address of assignee(number an. ti t 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
other county property Yes ❑No currretyear? 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.
COUNTY AUDITOR
Deduction approved in the amount of.
20_ 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
Ili; I/We ce ' 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
�'li, owner I ntract buyer of the aforementioned •.••perty on date application is filed.
Signor, - .. -rs furl.y- -) ■ Dale(m.,is,day,year)
IN .
F i resident address of ap., t(n •• - •street,city,state,and ZIP code)
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 ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.