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HomeMy WebLinkAboutMortgage_Besing STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year e*��== FOR DEDUCTION FROM ASSESSED VALUATION T State Form 43709(R13/10-15) g Prescribed by Department of Local Government Finance INSTRUCTIONS: File Mark To be hied in person or by mall. JUN •r leifiut 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 CountyAuddor or County Recorder of the county where the properly is ❑ County Auditor located on or before January 5 of the immediately succeeding calendar year. is . 'ecorder 2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of c•- ,u , '' A tir'nit. where the property is located during the twelve(12)months before March 31 of each year the dad .,. fNeJ-- t Oh r ' AUDITOR See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer.-see restrictions on Q rerse side) - 0 ..kA 1_7— CYl�r. , .-rl i Taxing District . u y r/legal desaption Record number Page number `�`n c� tom. iw 0 - t`I - I Y! -bnn. ©.hS 1 - aai- .2 0 11 ( -1-1 C. Assessed of reel property as of Mortgage/Contract indebtedness unpaid as of . Mortgage I Contract indebtedness unpaid as of is the apperart the sole date,anent years assessment date,current year date of apptcabon legal or equitable owner? Set) j..- D pas ❑ No If ro,what is his l 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: the property In' sessed Pr sled•�•. ":6-1.1-7)•-v.-of mortgagee or tract seller Q\ Address of mortgag .�contact seller(number and street city,state,and ZIP code) ' ee ,• v( Name of assignee or other owner or holler of mortgage / �� -`O \L Address of assignee(number and street coy,state,and ZIP code) • `N� Does applicant won property in any If yes.what county? What Taxing ` , - axing District? Has this dedw nN. .yes,state amount of deduction other county on property for. in Indiana?. -❑Yes o - anent year? L � A person is not entitled to is deduction unless the person has a balance on the person's mortgage or corn ,ebtedness that is recorded in the county ' recorder's office(including any home equity fine of credit that is recorded in the county recorder's office)that."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 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 t contract buyer of the aforementioned property on date application is filed. s (ownefs MI name) Date(month,day,year) CC /km fill- 13.go'At4' resident address of applicant(number and met city.state,and ZIP code) i'1 Jr/lo F /rain s�. /hackeq . Tit; g775 / �ss«« authorized by duly executed Power of Attorney or by 6-1.1-12-0.7 Date(month,day,year) _ _ Address of authorized person (number and street a1}: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.