HomeMy WebLinkAboutMortgage_Doty STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ggg �
State Form 43709 10-15) 9
Prescribed by Department of Local Government Finance ng ,J
INSTRUCTIONS: File Mark
Tobe filed in person or by mail (1(' 11 2p17 Form filed with:
Filing Dates- 1) Real Property.Must be completed and dated in the calendar year for which the &dudion is sought
M u s t be filed or postmarked w i t h the Courtly A u d i t o r or C o u n t y R e c o r d e r of the county . . . . .....sly is County Auditor
located on or before January 5 of the immediately succeeding calendar year. . ! 'l
2) Mobile/Manufactured Homes not assessed as Real Pro ,•"'� �r OgF 4, ❑ County Recorder
Property:Must file with • -�1•.>.�y� �.� 0
where the property is located during the twelve(12)months before March 31 - oeing•-:• is sought
See reverse side for additional instructions and qualifications. GtB �
Apptirvni or naci buyer-see renns orh ssle)
T-•: •isbict Key number/legal description Recall number Page number
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=•value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
date,aurerd year assessment Cda�te,,current year date of application legal or equitable owner?
�XJmn ❑ Yes ❑ No
If no,what is his 1 her road share of interest? If owned with someone other than effuse,inchoate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Property ❑ Annually Assessed
• Mobile Hare(IC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet city state,and ZIP code) pp\ r4
Does applicant own property in any If yes,what county? What Taring District? ]�L a\\�C 1. NO""• 'deduction
other county
in Indiana? ❑Yes ❑No
�� ..
A person is not entitled to this deduction unless the person has a balance on the per; No, ... ..........•• •the county
recorder's office(including any home equity line of credit that is recorded in the count Card
COUNTY AUDI
Deduction approved in the amount 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.
nature i fug name) Date(month,day,year)
Full resident-•dress of app. t(number and w>- city,state,and ZIP code)
/SC "nee "CZ o S ,&&6edsn't0 S 7XS7
Person authorized by duty executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dy,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.
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