HomeMy WebLinkAboutMortgage_Debord MSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
IT. FOR DEDUCTION FROM ASSESSED VALUATION N�JtY 1f
State Form 43709(R131 10-15) 11 ' N I .E D
Prescribed by Department of Local Government Finance g g ' l� •
INSTRUCTIONS: FEB. 1FFej
To be filed in person or by mail. Fonn filed with:
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 prope is . ty Auditor
located on or before January 5 of the immediately succeeding calendar year.
County Recorder
lo
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditeggo S'et'1NT"AUDITOR
where the properly is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. n
Appfi t(owner or a buyer- C on reverse //
T District (J/(), Key number I legal desoipbon �l/' Rewrd number Page number
.>GoQ.� � � G �l / 3 - .30o oo 3 . 5�9-00<7 �(0 37o1
Assessed value of real p as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assx•ment dab,armst year assessment date,amen year date of application R
legal or equitable owne
S
x000 0 Yes 0 No
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 pr perty in questin Annually Assessed
eal
Property ❑ Annually Assessed
• l Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ^ r /
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
De 13o et KyLE 1 —
Ad of assignee(number and street oily,state,and ZIP code) I fC ,.r7 t
` T - 5c,j Sc- ( 3 - a. _if 1. f,..)_73 A- c t' f u r —
Does applicant own property in any If yes,what county? What Taxing District? Has tt /1 — 2 !lr\/ —
other county on prc J-/V
in Indiana? ❑Yes ❑No curter
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or coma....____
recorders 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
S1/4
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.
kSig7ture(owner's lull ham ^ Date(month,day.year).524
XFul resident address of applicant(number and street,city,state,and ZIPccode)-
1353 S. 1v V:-\3o �1' I , - Ct1nuite`. r"N fLo10
Person authorized by duty 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.