HomeMy WebLinkAboutMortgage_Straw S STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 t 10-15)<
Presorted by Department of Local Government Finance
INSTRUCTIONS: ;
lb be Ned in person or by mail. , F. Form filed 'T. 'sa'
Filing Dates 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ 1y,Auditor
located on or before January 5 of the immediately succeeding calendar year ❑ County Recorder if 2) Mobile/Manufactured Homes not assessed as Real Properly:Must fife wrfh the County Auditor of t¢r con
where the properly is located d • the twelve(12)months before March 31 ofeactr year the deductkil: '� I' -"�.
See reverse side for o instructions and Ore! ). C pVti piuOlTpR
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Key number I legal description Record number
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value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appgcam the sole •
assessment dal,amend year assessment date,current year date of applicatowner?/� legal or equitable owner?
/ (2.)Q ❑ Yes ❑ No
If no.what is his!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 property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dry,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
m�Indwaia?? ❑Yes ❑No on fir? ❑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 Mat 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 aforemen ned property on date application is filed.
Signaanr- rut - / ' r Date(month,day,year)
.e
Full resident...� - py��
app ~number and-.-- P code)
V0 4 i et ih<Pith-. --7reQ q7(4 7 .
P —authorized by duly executed Power of Attorney or by IC 6 .1-12-0.7 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.