HomeMy WebLinkAboutMortgage_Bogan (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' � FOR DEDUCTION FROM ASSESSED VALUATION
-'- State Form 43709(R13110-15)
Presorted by Department of Local Government Finance if"'r L 1 1
INSTRUCTIONS: !J ark
To 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 is sought n r n`r
Must be filed or postmarked with the County Auditor or County Rece pr
rder of the county where the property is, 211 U] County Auditor
located 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 thelcounty County Recorder
where the properly is located during the Melva(12)months before March 31 of each year the deducbauis -•,,t�ff71Ir
See reverse side for additional intuitions and qualifications.
Applita (_vt_ coot�buyer-seere ' . on reverse ) 01630(1 C::;f: :.JCITC2
Taon , 0./ `—T/,
070, 7 �
Assessed value of real property as of Mortgage 1 Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assess-not date,current year assessment date,current year date of application legal or equitable owner?
1(0 t( Dot ❑ Yes ❑ No
If ro,what is his 1 her exact share of interest? If owned with someone other/than spouse,indicate with whom
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑ AnnualyAsssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and sheet,dry,state,and ZIP code) .
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and LP code)
a�applicant t own property in any If yes,what county? What Taxi _.- - I'tax this deduction been requested I If yes,state anoum of deduction
in Indiana? ❑yes ❑No
A person is not entitled to this deduction unless the poison has a bales 111/ ;corded in the county
recorders office(including any home equity fine of credit that is moon �/1(� // c`'1 y� Win.
Deduction approved in the amount of: w ee ITct )0
20 20 20 nS0 ,j 20
Signature of County Auditor County t•----.� t•----.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.
k S" re Il name)
u(n Date(month,day,year)
Full de�dress pptant 1ujl\�v an11--1ty,(sstt`ate,and ZIP code)
Person authorized� by duly executed Po�'ofP `y or"by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet 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 510,000. -77