HomeMy WebLinkAboutMortgage_Slinker (2) - STATEMENT R OF DEDUCTION MORTGAGFROM ASSESSE OR CONTRACT ED VALUATION INDEBTEDNESS County Township Year
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�-'^ State Form 43709(R13!10.15)
Prescnbed by Department of Local Government Finance
-de fTarTc
INSTRUCTIONS:
To ib
be filed in person or by mail. MAR tf rNFIT`"d':
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 wham the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. iO.,y.. Recorder•2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co•u .pinn f1;
where the property is located during the twelve(12)months before Mardi 31 of each year the dedtr ..O r.bU NTY AUDITOR
See reverse sid;V. additional instructions and qualifications.
Applicant(ow,d .•2••.ct.. - -see reverse side)
-2 i If i 9 7 7 r
L•, • r
strict Rey n !legal description Record pier Page ben
.•value of real property as of ge I Contract indebtedness unpaid as of Mortgage I Contract lnd ess unpaid as of Is the applicant the sole
assessment date,cement year assessment date,current year date of application/ legal or equitable owner?
fJ / 000 ❑ yes ❑ No
If nn,what is his I her exact sham 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
6 Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
•
Address of mortgagee or contract seller(number and sheet city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage __ _ • -
Address of assignee(number and street city,state,and ZIPc Drawer NO 001 .}
Does applicant own property in any If yes,what county? I I le(J ;fed If yes,state amount of deduction
other county Card NO.
in Indiana? ❑Yes ❑No - I No _
A person is not entitled to this deduction unless the per htedness that is recorded in the county
recorders office loch/ding any home equity line of aec Isis 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 tarred and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Sig--i.t - uric , Date(month,day,year)
fiF ,.et ad• - of applicant( mber and street,city,state,and ZIP code) l3/�0��!?
''J0;. ,tr. A ' Si Qwfsv �??o.�
Person authorized by duly executed Power o 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 hat years and a fine not to exceed$10,000.