HomeMy WebLinkAboutMortgage_Hunter STATEMENT
EDUC IO MORTGAGE S ED ALUAT INDEBTEDNESS County Township Year
Pf` � FOR DEDUCTION FROM ASSESSED VALUATION I
- '� State Form 43709(R13!10-15)
<- Presalbed by Department of Local Government Finance /
File Mark
INSTRUCTIONS: AP' si
To be filed in person or by mail. F/' °.
Filing Dates: 1) Real Properly 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 property is ❑ Cou Auditor
located on or before January 5 of the immediately suaeeding calendar year. ,. -. ao,jirrr,tiI!ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with The County Auditor of th C o
where the properly is located during the twelve(12)months before March 31 of each year the deduction is - - •See reverse side for additional instructions and qualifications.
Applicant(owner or tact buyer-see 2rons on�eve�rse side) n ��
Taxing District Key rhumber!o.-003.u..9.O00-Oita ) 90-oat Record`u�'f '°�
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage I Con,..ct indebtedness unpaid as of Is the applicant the sole •
assessment date,anent year assessment date,current year dal ica r legal or equitable owner?
1 o�,a'pl 4gfCPI./ ❑ yes 0 N
If no,what is his!her exact store of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile (IC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet city,state,e^-"'^--"
Does applicant own property in any If yes,what co ' aen requested If yes,state amount of deduction
other noun
in Indiana? ❑Yes ❑No �\.O �;f-e,C- O vv� QO"h� Yes ❑No ,
A person is not entitled to this deduction unless: v c� act indebtedness that is recorded in the county
recorder's office(including any home equity line Z\af{ tR O C�u a,- �.- . 0 t is the basis for the deduction.
Deduction approved in the amount of: rO v C-1 - ' -
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 coned and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
$1p N d�yMrd full n) A 1 Date(month,day,year)
Makt-Q A_
5477 �So1 +h 925 E+and ZIP G-I-y I ■ Ll7(ofoo
Person authorized by duty 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.