HomeMy WebLinkAboutMortgage_Claridge STATEMENT FOR OF DEDUCTION MORTGAGE FROM ASSESS OR CONTRACT
ED VALUATION
INDEBTEDNESS County Township Year
fl State Form 43709(R13/10-15)Prescribed by Department of Local Government Finance I
INSTRUCTIONS: File Mark
To be filed in person or by mail. MAY 14"2u •
l tn:
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 where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor My*
%-Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduct fibh ��110U
See reverse side for additional instructions and qualifications. T�'AUDITOR
Appli rat(ownerorq?naeclbuyer-soli (rayon reverse side)
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\)rig District Key number!legaldescriptbn R num Page tier
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app&ant the sole
assessment date,current year assessment date,current ear
Y plat a pliration legal or equitable owner?
If no,what is his If
/her exact share of interest? ` ' ' I`hNes ❑ No
owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the r
D operty in question:AnrivaAy Assessed
•
pf:eal Property 0 Annually Assessed
Name of mortgagee or con Iler Motile Home(IC 6-1.1-7)
lru t thei it o
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 street,city:state,and ZIP code)
Does count applicant own property in any If yes.what county? What Taxing District? Has this deduction been requested II yes,state amount of deduction
in Indiana? ❑Yes No on property for
current year? ❑Yes Li 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/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 l contract buyer of the aforementioned property on date application is filed.
Sign/ a(owner's lutl e) y year)
i n g_ ceeu Da�t�e{/-(month(g ,/
Fug resident ad/d� of app! nt(number and v� / )/ / '7 r �"
Sli Al. AIWA kV' //mss e.end Zi�TY 2 ( /V y-7tD 0
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 hall years and a fine not to exceed S10,000.