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State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance AR 3 0 2011
INSTRUCTIONS: /1�File Mark
To be filed in person or by mail. J/IloAs. ith:
Filing Dates: I) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. (�N COa ItEV pl IDIT9R
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prS4 LJ toon Au itor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Skipo, Sabrina L.
Taxing District Key number/legal description Record number Page number
Princeton 26-12-17-101-002.369-028/Kinkel Add 13 (17-2-10) 2,o1-1— MIA
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment dare,anent year assessment date,current year date of application legal or egwta owner?
68,900 0.00 80,514 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate wM whom
If name on record is dtferent than that of applicant,indicate below: Is the perty in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Movement Mortgage
Address of mortgagee or contract seller(number and street.city,state.and ZIP code)
8024 Calvin Hall Road, Indian Land, SC 29707
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 an If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes 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 in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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
owner/contra t buyer of the aforeme • ned property on date application is filed.
Si nature(ol,el ull name) y to(month,day,year)
Full re t address of applicant(r untber and beet city,state,a IP code) /r r
Person authorized by duly execute,Power of Attorney or by IC 61.1-12 .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 510,000.