HomeMy WebLinkAboutMortgage_Morgan . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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••,_ '% State Form 43709(R13110-15)
Presorted by Department of Local Government Finance pg
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INSTRUCTIONS: File Mark
To be filed in person or by mail FEB 2 616rwtth:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or posbnarked with the County Auditor or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. n
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the co
where where the property is located during the twelve(12)months before March 31 of each year the de dir�� rAtbU N�TYUAAUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or brad buyer-see
�G� s on reverse side)
`°� !
Taxing District ut '
number Pa ?g r
0( o -a - 3a3- 000a3b -oao 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
assessment date,current year assessment date,current year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his I 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 in question Annually Assessed
❑Real Property ❑ Annually Assessed
�/ Mobile Home(IC 6-1.1-7)
Name of mortgagee o contra-seller
41 /1 ,
Address of mortgagee or contra-seller(number and street city state,and ZIP e)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and 2
Does applicant own property in any If yes,what county M 01 1 T\ m n requested If yes,state amount of dedu-ion
other in Indiana? ❑yes ❑No a u t 1,_S Iy\ s 0 N
A person is not entitled to this deduction unless the :t indebtedness that is recorded in the county
recorder's office(including any home equity line of s 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.
rr�u tIname //�� onth der year)griejopers
d`
resident ad'address of applicant(number stand L coo'
tilt U Ced �, o. y ") Coc6
Person authorized by duty executed Power roily 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. ' • - •