HomeMy WebLinkAboutMortgage_Banks a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ce T Year
FOR DEDUCTION FROM ASSESSED VALUATION }(
1'1 State Forth 43709(R73/10.15)
`— Prescribed by Department of Local Government Finance �!
INSTRUCTIONS: MAR V 0
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
Must be filed or postmarked with The County Auditor or County Recorder of the county where the props • n Auditor
located on or before January 5 of the immediately succeeding calendar year. ``�,�'' CM b�yx Rgecorder
2) Mobile/Manufactured Homes not a ssed as Real Property:Must file with the County AuditoaOtBSOHrQO UN� L�IiPOK
where the properly is located during the -!w(12)months before March 31 of each year the deduction is sought
See reverse sid=for additional instructions and quail •.,'ins.
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Apptaant .. - conbadbuyer- . . .rseside -
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arse nu, .> I�al description+ Record number umgpr
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,current year assessment date,current year date of application legal or equitable owner?
3 1i��P�� ❑ Yes El No
If no,what is his/her exact share of interest? If owned with someone other spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is property in question:Annually Assessed
Real Property ❑ AnnualyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contact 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 county property for Indiana? Yes ❑No current Yes ❑No
A person is not entitled to this deduction unless the persr'--- —`^"" nn the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit basis for the deduction.
Deduction approved in the amount of. Drawer NO,ROI 7-
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20 20 20_ Card NO 900 20 20
Signature of County Auditor Date(month,day,year)
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I/We certify under the penalty of perjury that the eh, - • . ' the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application lb Dieu. •Signature(owners name) Date(month,day,year) ,
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Full refddent ad d. sssssss ap j aril(number and street,ay,state,and ZIP code)
/080/I E. /25 A'
Person authorized by duty executed Power of Attorney or by IC 6-11-12-0.7 Date(month,day,year)
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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.
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