HomeMy WebLinkAboutMortgage_Marion (2) PaSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fenn 43709(813110-15) .- - ;
Prescribed by Department of Local Government Finance I, 1 a.
.
INSTRUCTIONS: I i ' - "' S.
To be filed in person or by mail with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought. JUL 30117
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is IanMY Auditor
located on or before January 5 of the immediately succeeding calendar year. - M Recorder
2) Mobile/Manufactured Homes not assessed as Read Property.Must file with the County Auditor of the to 11 a
where the property is located during the twelve(12)months before Mann 31 of each year to dad rib:,:. -,141,-f' '�'� ii
See reverse side for addtionalinstructions and qualifications. • COUNTY AUDITOR
( orcnntract 72see Wardorevetse side) - . number
Key, i9-37-Jo/ OW. �410-o09 Record Page
value of reeI property as of Mortgage/Contract indebtedness unpaid as of • Mortgage I Coneac indebtedness unpaid as of Is the applicant the sole
assessment daM,current year assessment date,anent year date of application /n legal or equable owner?
�U/MD ❑ 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 property in question:AnnualyAssessed
Walla Real ❑ Mo Home QC 6-1.1-7)
Nacre of mortgagee or contract seller c.Q'
Address of mortgagee or contract seller(number and street city,state,and Zle) •.ei1[^�//
•
Name of assignee or other owner or holder of mortga e y � 4
Address of assignee(number and street,ray,state,and ZI de) .
•
Does applicant own phupeity in any If yes,what county? - What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ❑ property for
in
Indiana? Yes ❑No current year? ❑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(inducting any home equity fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDr°o ' -
Derludion approved in the amount of: • �'� Q,( �l 2� C"t
; ply y
20 20 20 20 In(...,NE \o y� 1 0 UC'� D
Signature of County Auditor _ Count 2 -p `000. b \— `\— I.l .
I/We certify under the penalty of perjury that the above and foregoing Cl 0 .
oregoing information i 0, ` — ``5 1 liana and
owner!contrail r of the aforementioned property on date application is filed.
(oNne S, )
Data(month,day year)
Fd rivmaalYaddres of ( and street,cty,state, ZIP )
?i 3 ra-a lit,f 1';ac `7/773g
Person authorized by duly executed Power of Attorney or by IC 51.1-12-0.7 Date(month,day.year)
Addmss of authorized person (number and scree!,Sy,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.