HomeMy WebLinkAboutMortgage_Graper (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) FT
Prescribed by Department of Local Government Finance - J E
INSTRUCTIONS: • File Ma
To be filed in persona by marl. SEP 22 Zr. filedwit:
Filing Dater 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 County Author or County Recorder of the county where the pro.-rty is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year _ t,—iI -.if'M •unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County A 'm114
where the property is located during the twelve(12)months before March 31 of each yearth h CsOttitflY AUDITOR
See reverse side for additional
Taxing District Key number t legal description Record number Page number
M a6-/9- i8— jod - ovo, 7 7 of — e G ,0/7 3833
Assessed value of real property as of Mortgage!Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,curtest year assessment date,current year date of application legal or equitable owner?
GO DOD ❑ Yes No
If no,what is his/her exact share of interest? If owned with someone other than grits,indicate with whom
If name on rend is different than that of applicant,indicate belay Is the property in question Annually Assessed
'Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller Er {'^
Address of mortgagee or contact seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee n ,r and steep,state,and ZIP coyeJ'
Does applicant own property in any If yes,what county? What What Taxing District? Has this deduction been requested If yes,state amount of deduction
other cou aPn�R r
in Indiana? ❑Yes No current ❑Yes- ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the county
recorder's office(including any home equity line 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 oe
20 - 20 20 20 20 20 20
Signature of County Auditor County - Date(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 application is filed.
Signatiugfrovmers cup nar�1me)2 Date(,un.th,day,year)
Full resident address of applicant(number and dty,state-and ZIP e)
A6om1 7re+tel- Pst-k DYti%) , Ft i e2r41-'ui I 47by ?
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date m nth,day,year)
Address of authorized person (number and street city,state,and ZIP axle)
The penalties for perjury can include imprisonment up to hvo and a half years and a fine not to exceed$10,000.