HomeMy WebLinkAboutMortgage_Angle (2) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
.f n FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 I 10.15) .
`— Prescribed by Department of Local Government Finance t� ��-
INSTRUCTIONS: • � i I ' . 7
To be filed in person or by mail. Form filed with:
Filing Data 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought ff11 Ti Must be filed orposbnarked with the County Audtor or County Recorder of the county where the property isr C T aunty Auditor
located on or before January 5 of the immediately succeeding calendar year ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coun
where the properly is located during the twelve(12)months before March 31 of each year the deduction is N41.7 .iirmiht
See reverse side for additional instructions and quaffications.
A�nt(aaneror,,,,,,tract buye- sestricaw+s rses�ee) CIBSOI'! COUNTY AUDITOR
Taxing District c " r —1. - a o a-coo• oo i oos Record numQe 3/9 p number
Assessed value of real property as of l0 Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as ofd/) Is the applicant the sole
assessment date,current year assessmer parent year date of application legal or equitable owner?
°f{J,[� (!(h2 ❑ Yes ❑ No
If no,what is his/her exact share of bitterest? If owned with someone other than spouse.indicate with wham
If name on record is different than that of applicant indicate bete Is the property hi question:Annually Assessed
❑Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ,� n
Address of mortgagee or contact seller(number and sheet clt CU state,and ZIP Pwde) e -1 VLl ti nv,f 1'.
Name of assignee or other owner or holder of mortgage 4p V N 1 3,- 1,
Address of 1JCI— 3 `,l
assignee(number and street city,state,and ZIP code)
Does a town r �J 1LS 1
other property in any If yes,what county? Waal Taring Dish 1 artaum of deduction
in Indiana? ❑Yes ❑No I a rieni yeari. LI Yes. ❑No
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 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 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 I contract buyer of the aforementioned property on date application is filed.
e(owners full name) Date(month,day,year)
fffjjAuu�l r� n be L (�'—/ 7—/ 'l
Oof applicant(n her` ,an ZIP-c code) r� Li) 14
Person authorized by duly�-executed Power of Attorney or by IC 1-1.1-12 0.7�/Nr_` �1 J,_V-L Date(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.