HomeMy WebLinkAboutMortgage_Mason ,< STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION �����
` e State Fonn 43709(R13/10-15)
Preserbed by Department of Local Government Finance
INSTRUCTIONS:
File be
To be filed in person or by mail. NOV 2 U 2 2rrn Med with:
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the dedrxn is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county when:Me pro.- is .• -•unty Auditor
located on or before January 5 of the immediately succeeding calendar year. // x i"7jfi;
2) Mobde/Manufactured Homes not assessed as Real Property:Must Me with the County Au.i.. .1 I a , • County Recorder
where the property is located during the twelve(12)months before March 31 of each year enti "ft . -..1!r Y R
See reverse side for additional instructions and qualifications.
•L _nom_ .�C1- -- reverse'M�.9 or- _
T<�� cn l ./legal q-q X03-a01- 2 (ss— OD-( 2 `1 �� rr0
Assessedvvalue of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,anent year date of appy legal or egti a owner?
5L(\\ O U 6 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other titan spouse,indicate with whom
If name on record is different than that of applicant,indicate below Is the in question:Annually Assessed
. -alProperty ❑ Annually Assessed
N biie Hone(IC 6-1.1-7)
Name of mortgagee or contract seller ^ \� \n orj„. Q
Address of mortgagee or contact sellerr(n(number and abet`city,sate.,aannd``ZIP c /\'code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
no(u --1
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been req If yes,state amount of deduction
other county ❑Yes ❑No current year? ❑yes. El 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(inducting any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
Deduction approved in the ama
20 2 20 20 20
Drawer NO c7(3 \ --
—
Signature of County Auditor 'yI Date(month,day,year)
•
I I We certify under the pe Card a I d N O- ` & and cored and that the applicant is a resident of Indiana and
• contract buyer of f
Sig ..owneYS fun name .. - .__. Date(month,day,yea)
X. /� JL 791 a•
dress m IP
and J, code) �7 B' jj
Personauthorized 7
by duly executed Power of Attorney or by IC e-1.1-12-0.77 Date(month,day.year)
Address of authorized person (number and street clay,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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