HomeMy WebLinkAboutMortgage_Halcomb ? STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN J 1 T y ownship Year
FOR DEDUCTION FROM ASSESSED VALUATION L/
' State Fart 43709(R13!1615) - . •
Prescribed by Department of Local Government Finance J J N 0 1 2317
INSTRUCTIONS: File Mark
To be filed in person or by mad. Forrn fiord with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the d-• .'• j-)y,..-aim*,
Must be filed orposimarlced with the County Auditor or County Recorder ofthe,cwrntv .sr ' v -,p`lt•A'�1DITn R❑ County Auditor ,
located on or before January 5 of the immediately succeeding calendar year. GG�166 ❑ Courtly Recorder
2) Mobile I Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sough..
See reverse side for additional instructions and qualifications. ___ /_ •
qt Kt- 17.1- on reverse sdel „+"r{..Yl�A72Z
Tanning D. / /legal description Read
?n/it cf�/ c6-i9-�9 - /o /040791 CIS to ! ! Jt'S
Assessed value of mai probeity as of Mortgage f Contract indebtedness unpaid as of • Mortgage t Contract indebtedness unpaid as of Is the appinrtl the sole
assessrnerd date,current year assessment date,anent year data of applcalion legal or equitable owner?
/1/ 705 • ❑ Yes ❑ No.
u no,what s his/her exact share of interest? If owned with someone other than sprwvca,iodiae 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 61.1-7)
•
Name of mortgagee or mntractlx3 ..
Address of mortgagee or contract seller(number and street,city,state,and LP code)
Name of assignee or other owner or holder of mortgage '
•
Address of assignee(munberand street,rely 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 on OrenedY fat in ? ❑Yes El No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the perm has a balance on the person's mortgage or contract indebtedness that is recorded in the county '-
recorder's office(including any home equrly fine of coedit 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 Anditor County Date(manor,day,year) • - —_
I 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 afore property on date application is filed.
7 Fug reside( freename) / Date(north,day.year)
male9A D- /�
authorized by duly executed Attorney ey or by IC 6-1.1-12-0.7 f Date(nrorh,day,yen)
Address of authorized person (number and area;obi sate,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.