HomeMy WebLinkAboutMortgage_Martin (3) a.., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
'- Slale Form 43709(R13/10-15) . •
Prescribed by Department of Local Government Finance
INSTRUCTIONS: LE o
To be filed in JUL 6 'Mr wlut
Filing Dates: I)) Real bP perty.Must be completed and dated in the calendar year for which the deduction is sought F
Must be flied or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Author
located on or before January 5 of the immediately succeeding calendar year. ,
2) Mobile/Manufactured Homes not assessed as Real Property. Must file with the County Auditor of the ...gr:.• �•/ - • Recorder
�MrIr
See reverse side for additional instructions during ualifcatio (12) before March 31 of each year the dew®�i' UNTY 4tJ `t}H
7 ( mrmaa:�f/�see re fa• reverse side) /� '•c //-At Q,
v�•7 .t 7L e
H.a -3 - Oa'-ate. 17‘- OO9 2 3
Assessed value drawl property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the appfiond the sole
assessment date.anent year assessrr®rd date,anent year data of application legal or equitable owner?
If no,what is his I her exact share of interest? If owned with.someone other � ❑ Yes ❑ No
spouse,irlrfipte with whom
If name on recall is drHaerd than that of appfnarrt,intricate below: Ls the property in question:Annually Assessed
eat Properly ❑ Amrual y Assessed
/ Mobile Home QC 6-1.1-7)
Nana of mortgagee or aoNract seller n /1
Address of mortgages or contact seller(number and aandd street city,stale,and ZIP code)
Zip_jet.a)
Named assignee or other owner or holder of mortgage cap .9
Address d assignee(nrnrberand street ally,state,and ij"c ) U
Does applicant own property in any If yes.what county?V- ?Alai Taxing District? Has this deduction been requested If yes,slate amount of deduction
other
Indrar�? ❑Yes ❑No - ammm�t y�ea•R ❑Yes El 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 fine 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 —_I 20 20
Signature d County Atrddor County �0 (Z , ce4 _--- -
I I We certify under the penalty of perjury that the above and foregoing information is true an �Q.j • id
owner I contract buyer of the aforementioned property on date application is filed. r he_- ` 'CILC , �l
\ F revderd ad ap., . .rrrrxber shat . ZIP • -t O�ti,1 0 ��
/09 ill i�r t ((7��
Person authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(mom.,....,,,-
Address of authorized person (number and street,a11:state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510.000. - -