HomeMy WebLinkAboutMortgage_Bobbitt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court — Year
ic`'- FOR DEDUCTION FROM ASSESSED VALUATION
.. 't State Forth 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: .APR1 FRO17
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought n,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property I Il,,,... my Auditor
located on or before January 5 of the immediately succeeding calendar year RU PP
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of l countyy C OU coauvrRearder
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(owp w buyer-see on I
Taring District Key ` I—{q �O] I - ODD• SI O co 1 1/7 number Pag/'738
Assessed value of real property as of Mort gage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as o Is the applicant sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
3 ( ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone of er 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 ❑ Annual 'Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee a contract seller umber and sheet % ,state.and ZIP code
II II •
Name of assignee or other owner or holder of mortgage
4
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 aunty 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 recorders 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 I County - Date(month,day,year)
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/contract buyer of the aforementioned property on date application is filed.
Si, ture(owner's turf/ ) Dale(month,day,yea
/r' 9 If-2c --1(1
en aE ress of applicant(num and street city,state,and ZIP code)
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.