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HomeMy WebLinkAboutMortgage_Smith (41) 3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year .,o FOR DEDUCTION FROM ASSESSED VALUATION ` -'• State Form 43709(R13/10-15) gg--yy g Presorted by Department of Local Government Finance i �Fi! -_all. INSTRUCTIONS: g! To be filed in person or by mait orm sled with: 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 prape W 2 5 I rgii County Auditor located on or before January 5 of the immediately succeeding calendar year. 2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county County Recorder where the property is located during the twelve(12)months before March 31 of each year the deduction j..ught a Vii- Seereversesideforadditionalinstructionsandqualifications. If •• -WM.. merorcontract bu see reseicbonsonre w side) GIBSON GOON I AUUI I UK Taxing District /7Odesdt ©oi t TT- o Record nu t h 911 number 3 Assessed value of real property as of WW��Mortgage!Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appliiccant( the sole assessment date,current year assessment dat2, _ rn yeaa date of application legal or equitable owner? 4 60 U ❑ Yes ❑ No if no.what is his I 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 below. . Is the property in question:Annually Assessed ❑ Real Property ❑ Annually Assessed • Mobile Home(IC 6-1.1-7) Name of mortgagee or contrail seller -- _ Address of mortgagee or contact seller(number: E Ly ssr-i Sint rN Ty LE7L MAS0 Name of assignee or other owner or holder of mot I (1 -1)53 • Address of assignee(number and street,dry;scat Does applicant own property in any If yes,wha ton been requested If yes,state amount of deduction other county rent ye ..r in Indiana? ❑Yes ❑No I I auah ❑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 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 flue and correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. - Sig r�narpe) / �q Date(month,day,year) F>�eoL �(ess giapp�Y+'fican /-`beruln and.itreet,dry,state.a(,{�Lpode)]�/��1/1 "L 2‘70! 0 Person authorized Uedd by_duty executed PoweerrofAttom-rneey or by IC 6-1.1-12-0.7 ° _ Date(month,day,year) ._ Address of authorized person (number and sheet dry,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.