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HomeMy WebLinkAboutMortgage_Duval (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year S.-4' °- :7 FOR DEDUCTION FROM ASSESSED VALUATION • '`$��a State Form 43709(R13/10-15)•<--- Presamed by Department of Local Government Finance �1er�-'-1,,T T � ! INSTRUC77ONS: g JL J6� t / To be filed in person or by mail. Form Wed with: Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought n�I�((�l }}}},, Must be filed orposbnarked with the County Auditor or County Recorder of the county where the propsIl Os 2 '0 L'� County 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...•unty where the property is located during the twelve(12)months before March 3/of each year the ded .%.. ;,h• 2.•4.l1gi, See re side for additional instructions and qualifications. �/) (Stan: (n' �1N IrA11n ��1p' GIBC0n1 r CWMTV bIini-rnp -....,� a _ ,';trail buyarV 4- i VI .12J2A.1 �. '. amng number l legal 4 Retard number Page number Assessed value of real property as of Mortgage I Contrail indebtedness �as of/' �� indebtedness unpaid of Is the app&ant 2 sole assessment date,current year assessment date,aurent year datepFV` ion legal or equitable owner? l_,l/ ❑ yes ❑ No If no,what is his 1 her end share of interest? If owned with someone other than spouse,indicate with whom If nacre on record is dierem than that of appfimnl,indicate below: Is the property in question:Annually Assessed ❑ Real Property ❑ Annually Assessed Mobile Hone(IC 6-11-7) Name of mortgagee or contact seller 5 I3 Address of mortgagee or contract seller(number and sheet ay,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)) , Does applicant own property in any If yes,w ) O —D.....1-)__ wart requested If yes,state amount of deduction other county in Indiana? ❑Yes ❑No �G/ !Yes. ❑No A person is not entitled to this deduction a Drawer N O tract indebtedness that is recorded in the county recorder's office(including any home equh �� at is the basis for the deduction. Deduction approved m the amount of: Card N O. 20 20 20 20 20 20 20 Signature of County Auditor County • Data(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 l contract buyer of the aforementioned property on date application is filed. "cure( full name) Date(month,day,yeas) Full address of applicant(number and sheet city,slate,and ZIP "e q 30 Lid ©a..-g- C� �► 41 CA0 o P authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number and street dry,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.