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HomeMy WebLinkAboutMortgage_Ducharme (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R13/10-15) �-- Prescribed by Department of Local Government Finance INSTRUCTIONS: • ITcf Fong filed in person by mail. si ry Filing Dates 1 1 Real Real l l Property.Must be completed and dated in the calendar year for which the deduction is sough[ ( 1. M ust be filed or postmarked with the County Auditor or County Recorder of the county where the property is LJ County Auditor boated 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 O C 4 EFIV9 Recorder where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought See reverse • additional instructions and qualficafions. Apt>rcant(. _ • contract buyer-see res733 on reverSe'Nde) ' Cr �e�� /C�n / Q 2 `y) GIBSOnuNrJ�DC/OUNTY AUDITOR Taxdn9 District 6 1fl r I Odd T C —l D 3—©D I• .� t 3�O Record I I 1 7✓ Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessmerd date,=rant year assessment data,current year date \J legal or equitable owner? �s7 �" ❑ Yes ❑ No If no,what is his l her exact share of interest? If owned with someone other than spouse,indicate with whom If name on read 5 different than that of applicant indicate below is the property in question[Annually Assessed ❑ Real Property ❑ AnnuallyAssessed //� �rx �}�q, ,� Mobie Hone(IC 61.1-7) Name of mortgagee contract seller CO/�� �`C/1`-'�Y \ 1`0W V4./ ]— 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(number and street city,state,and ZIP code) Does applicant own property in any If yes,what county? Mal Taxing District? Has this deduction been requested If yes,state amount of deduction or 'mnInddiaannan? ❑Yes ❑No con ear? ❑Yes. ID 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 coned and that the applicant is a resident of Indiana and owner/co buyer of the men,' n d property on date application is filed. S10; e • :. tutIname) Date(month,da are 10-1X-11 tat adtl a36ca jambe ar d sDeet city,orate n jlP code) Li .26 7 0 cCin Person authorized by duly executed Power of oof-At(t)o`rn'ey or by IC -12.0.7 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. r