HomeMy WebLinkAboutMortgage_Miller (2) ;„„a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13(10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. FEB 28 r ttrWn filed with:
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 pro.- is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year •, .ice .only Recorder
2) where the property Manufactured during the twelve(12)months before Must file March with o each year
�:f ?.r fat ia'y • t ITOR
See reverse side for additional instructions and qualifications.
Applicant(Cr or contract
t-12 er-see on reverse side) „ • �(� %� lS
Taxing District (n�/(,l,L�/1_ /� , umber
r(r legal
't -�o I ot�CJo..l„r rq-org R l'P '18'I a
Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of rtgage!Contract indebtedness unpaid as of Is the applicant the sole assessnent dabs,=rent year I assessment date,current year -- eo application legal or owner?
equitable owne
I ❑ Yes ❑ 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 property rt1 question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ^
( � �c U
Address of mortgagee or contract seller(number and street city,state.and ZIP 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
other Yes E1 No currennty�ear?? ❑Yes 0 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
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
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
er/contract buyer of the aforementioned property on date application is filed.
re full -- e) r- Date(month,day,year)
FuA esident..•. --ofa•• t( mbar and steak state, rip cotl Li)GVQ
q i, 11x_-Y~-Y}•,
'Person authorized by duty executed of Attorney or by IC 6-1.1- 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.