HomeMy WebLinkAboutMortgage_Huff (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTED -. Core)fl\ Township Year
•;. FOR DEDUCTION FROM ASSESSED VALUATION
- ...- State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: OCT 6 2011 File Mark
b be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction i, ught
Must be filed orpostmadced with the County Auditor or County Recorder of the county wharf County Auditor
located on or before January 5 of the immediately succeeding calendar year. wNN���(�t NTY AUDIT
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the 631$gt9bdrror'oi the county County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deducion is sought
See reverse side for additional instructions and qualifications.
Applica�or contrail buyer-see restrict rrs on rave side)
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T Keg number l legal ` /� Recoil number Page number
i Ri,Y�.tyv a /0-era - -3o I -coo . 3 )9 -oa i( aoi7 //CC-3
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year
assessna date,qrealjaar date of apprration legal or equitable owner?
g ❑ Yes ❑ No
If no.what is his 1 her exact share of interest? If owned with someone other than rise,indicate with whom
If name on record is different than that of applicant.indicate below. Is the property in question:Annually Assessed
Teal Property ❑ AnnuamyAssessed
• / Mobile Home(IC 61.1-7)
Name of mortgag7n Q y
Address of mortgagee or contract seller(number nd street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage _
Dfaiye't. t\ 111
Address of assignee(number and street city,stare,and ZIP code) O•..,(2G 1.• _(_•
Does applicant ap awn property in any If yes,what county? What Taxing District? Has Ca/4 No. / (^\ .r on in Indiana? ❑Yes ❑No amen .....h.�.v�.
A person is not entitled to this deduction unless the person has a balance on the person's mortgage M __ rty
mcorder's office(including any home equity line of credit that is recorded in the county recorders office)that is the uww..._.
COUNTY AUDITOR
Deduction approved in the amount of.
20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,yeah
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(owners huDn e) Date(month,day,year)
N u-li rr i lent address or I`$ It(number and street city,state,and ZIP code) ``
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Person authorized by duty executed Power of Attorney or by IC 5-1.1-12-0.7 Data(month,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.