HomeMy WebLinkAboutMortgage_Boyd (2) •
, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I
Qom
l? FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) .•
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by marl Form tiled with
Rung Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought. CC FF H,
r
Must be filed or posbnarked with the County Auditor or County Recorder of the county where the propertytt P 1 2 CJCounty Auditor .
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 Recorder
where the property is located during the Melva(12)months before March 31 of each year the deduction•
See reverse side for addtio-onall instructions and qualifications. G taSON COUNTY AUDITOR,
Appftmm( 1 B.
Taxing District /1 ( number a number
b- 1 ? i aoa-oao. s+s- pad, Rail
Assessed value of rat property as of Mortgage/Contact indebtedness unpaid as of . /Contact unpaid paid as of Is the applicant the sole
assessment date,current year assessnmd date,current year -on legal or equitable corer?
00 ❑ Yes ❑ No
If no,what is his t her exact share of interest? If owned with someone other than spry Mme,indicate with whom •
If name on record's different than that of applcant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ AnnitaIy Assessed
tAobOe Home(IC 6-1.1-7)
Barre of mortgagee or contact safer
&ran -
Address of mortgagee or contact seller(number and street city,state,and ZIP )
Name of assignee or other owner or homer of mortgage '
•
Address of assignee(number and street wily,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 arnoum of deduction
other in Narha? ❑Yes No ament�? ❑Yes 0 N
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 fee of credit that is recorded in the county rerxrrder'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 CowdyAuddor County Data(month,day,year) •
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 aforementioned property on date ap•' On is filed.
fug name) Date(monfi,day,year)
F address XtC1T/• _ , X7(0 -7 Date(month,day,year)
(1C)
Address of authorized person (number and street ray,
reet slate,and ZIP code)
authorized
The penal ties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.