HomeMy WebLinkAboutMortgage_Hasenour (7) S 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:
b be filed in person or by mail. q • filed with:
Filing Oates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought MAR 2 4 21
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is PIS County Auditor
located on or before January 5 of the immediately succeeding calendar year. 4,31,-1/
• •unty Recorder
2) Mobde/Manufactured Homes not assessed as Real Property:Must file with the County Auditor o -if: ;,-
where the property is located during the twelve(12)months before March 31 of each year tl®._ • • l 1'
See reverse si.-for additional instructions and ualifcations. � `I� � � AUDITOR
Applicant(. •- or contra• buyer see re on verse side) ,,/
1/ J % !( /d t QI(.1�i, OM.2ua-) ] 4
Taxing D'... / Key description Record number Page Page number
/A , Jr/ J/-070/- Qom. 34 % 6.1aT7 aoi 2 •
Ae A}, value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
r -rem date, assessment date,current year date of application legal or equitable owne°
❑ Yes ❑ No
If no,what is his 1 her exa re 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 property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /21E- /JI_k_
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
Name of assignee or other holder of age ZC
(ctv
Address of assignee(number an et,city:state,and VP 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
in Indiana? Yes El No current year? ❑Yes ❑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
recorder's 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
N- kV 20 �y�e Nc_se,.ti,,,,,y---
20 20 20
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Signature of Coun I 0 v‘c_ f�� � County • Date(month,day,year)
ao � I r V
I I We certify y a e a p O ffomlation is true and correct and that the applicant is a resident of Indiana and
owner/cord `7,co m is filed.
Sigma owne �,1�' 3 Date(month,day,year)
l'
ELM,resident address of applicant(number and sheet,city.state,and ZIP code)
9 r) t,iJ G 75- 5 1104,-60- N ,Ai y 7 6 3 ?(
Person authorized by duly 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. _ . - -. . -