HomeMy WebLinkAboutMortgage_Lamon STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
', FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709(R13/10-15)
-�- - Prescribed by Department of Local Government Finance
INSTRUCTIONS: - Flt
To be filed in person or by mail. Form filed with:
Filing Oates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought ,�f
• Must be filed or postmarked with the County Auditor or County Recorder of the county where the properMAy 2 4 ]County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Pro County Recorder
Property:Must file with the County Auditor of the county
where the properly is located during the twehe(12)months before March 31 of each year the deduction is i
See reverse side for additional instructions and qualifications.
Appficantyyerperorconrract -seer o4r_ts rise ,� GISSuNCOuNTY AuuiiUK
Taring District icy �1�,' `1:��+�G/��.n.. �.c•/m.o'►l Record number Page number
- 141-1 e- NO3- 000.013 -007 1 '7 /54/ .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
, ,OD ❑ Yes ❑ No
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate helorr. - Is the property in question:Annually Assessed
❑Real Property ❑ AnnuafyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5/
3
Address of mortgagee or contact seller(number and street ay,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number end sheet,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
innIndiaianna? ❑Yes ❑No cuurreentt year? ❑Yes- ❑No
A person is not entitled to this deduction unlPSc 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 aedit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
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
er I contract buyer of the aforeme I' ned properly on date application is filed.
afindemi
- ) Date(month,day,year)
F • ent address nta ' (nu . steel. : •state rid ZIP code) 9— —'
11 C (6aJ ., l a 41(060
Person aut oriz by duly executed Power of Attorney•C IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and sleet 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. -