Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
Mortgage_Deffendall (5) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
f "it
G FOR DEDUCTION FROM ASSESSED VALUATION
1,.:. °` State FOrtn 43709(R73/10.75)
S / Presrnbed by Department of Local Government Finance i
{TJ FJ LED
E l)
INSTRUCTIONS: ll
To 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 �tr-q nt
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is J t 1713 4oam+7auditor
located on or before January 5 of the immediately succeeding calendar year. Ill 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is __--,..----.1
,i' t r
See reverse side for additional instructions and qualifications. (y� CIBSON COUNTY AUDITOR
Applicant(owner see
Kytsm'rm� o�n reverse side) I/f��/'� /� /� ��.f
man
Taring District �Vll n� S/ J 3— y) _00 a �J 3�Va" / Record number Page numoe f
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,current year date of application legal or equitable owner?
I(0 Oi ❑ yes ❑ No
If no,what is his I her exact share of interest? If owned with someone ober than spouse.intricate with whom
If name on record is different than that of appricant M. Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage ol-0i7 - cra g h
Drawer NO................./../
Address of assignee(number and street,city,state,and ZIP code)
Card iNO, 02 Ct
Does applicant own property in any If yes,what county? If yes,state amount of deduction
county
other County
in Indiana? ❑Yes ❑No '
A person is not entitled to this deduction unless the person. ress that is recorded in the county
recorder's office(including any home equity line of credit that is few...._._ _ - for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of Canty Auditor County Date(month,day,year)
I/ e 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
er 1 contract buyer of the aforementioned property on date application is filed.
na (owners full name) Date(month,day,year)lif
Fulllresi*nl address of r t(num and scree tiff
d ZlP j L
Person authorized by duty executed mey or by IC 61.1-12-00..7J{{jj����'',-�y�_�` r'l 4-) l� Date(month,day,year)
•
Address of authorized person (number and street city slate,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.