HomeMy WebLinkAboutMortgage_Aparicio a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ,;},^„►, Township Year
FOR DEDUCTION FROM ASSESSED VALUATION 13._.41
-` State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: Mp`l 61.% 20\1 File Mark� _
To be filed in person or by mail.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is soug r _Ai
Must be filed orpostmarlced with the County Auditor or County Recorder of the county - th,,4'7. .t& tcO�� County Auditor
boated on or before January 5 of the immediately succeeding calendar year. P
2) Mobile/Manufactured Homes not assessed as Real Pro M't Y ❑ County Recorder
Properly:Must file with the Courdy -r.•t .� • e county
where the property is located during the twelve(12)months before Match 31 o! r..: is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or a buyer-see restrictions on reveae side) •
T �I �„J— f legal�desu'rytion Record number Page number
/1/� row Ric-/a -iS- /O / 003 i6 aaa R R0/ /.337
Assessed value of real property as of Mortgage/Contract indebtedness npaid as of Mortg /Contract indebtedness unpaid as of Is the applicant sole
assessment data,current year assessment dale,current year date of pplicatlon legal or equitable owner?
r 5 -2 o Ant 7r,r4 a ❑ Yes ❑ No
If no,what is his t her exact share of interest? I I>'owned with someone other than spouse,indicate with whom
If name on record is deferent than that of applicant indicate below. • ry/ Is the property in question:Annually Assessed
. ^peal Property ❑ AnnuallyAssessed
Mobile dome(IC 6-1.1-7)
Name of rirrtgry ow contract seller)
Address seller(number� �t 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 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 ❑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
rears 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/contract buyer of the aforementioned property on date application is filed.
Signature((owner's tub name) at Date(�� da���
(- C6 N -: l /
Full resident address of applicant(n and ,and ZIP code)
R'3 e S pier_—,
Person authorized by duly executed Power of or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street may,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.