HomeMy WebLinkAboutMortgage_Monroe (2) a,> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County / Township Year u FOR DEDUCTION FROM ASSESSED VALUATION
�' State Form 43709(R13/10-15)
�= Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County 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 county County Recorder
where the properly is located during the hvehe(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or aad -see resat rivers on )
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Taxing District Key number!legal description Record number Page number
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Assessed_
assessment date,current property as of assessment date,current morass unpaid as of ��geapplii application indebtedness unpaid as of legal or eq�uitable owner?
?go es ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom
If name on record S different than that of apprrcant indicate below Is the properly in question:Annually Assessed
'l$eal Property ❑ AnnuatlyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgageAor=tract seller /`��g1F/1
Address of ���seller(number and street.city, ,and ZIP code)
Name of assignee or other owner or holder of mortgage —
Address of assignee(number and street city,state,and ZIP code)
Des applicant own property in any If yes,what county? Withal Taxing District? D f-aa 15'C r �1 O • �O,� nt of dedur3ion
in Indiana? ❑Yes ❑No �/ ��\},�(/
A person is not entitled to this deduction unless the person has a balance on the Card 1N1 O. L`-' / t fed in the county
recorder's office(including any home equity line of credit that is recorded in the
COUNTY,
Deduction approved in the amamt of
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.
Signature(owner's e) /)4� Date(month,day,year)
Full resident address of appliiant(number sweet city, ,and ZIP code)
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'Person authorized by duly Power of Attorney or by lC61.1-12.0.7 Date(nruertr,day,year)
Address of authorized person (number and street city,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.