HomeMy WebLinkAboutMortgage_Davidson (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTE .
_.. El) Township Year
1�}� FOR DEDUCTION FROM ASSESSED VALUATION >}giJ e�lh
Stare Fomr 43709(R131 10-15)
"---• Presatbed by Department of Local Government Finance
INSTRUCTIONS: DEC 1.2 2017 File Mark
To be filed in person or by mad. Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the ded • is pa .1 t
Must be filed or postmarked with the County Auditor or County Recorder of the oou r,I it dry;f; ,:i jo7l7r is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. T AUDITOR
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with��'gudrtor'df the county ❑ County Recorder
where the properly is located during the helve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
buyer-see restricd on reverse side
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Taiihgp,, Key number I legal description t� e' Record number Panne number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
assessment dare,anent year assessment date,current year date of application legal or equitable owner?
55 c1d ❑ yes ❑ No
If no,what is his I her exact store of interest? If owned with someone other than spouse,imitate with whom
If name on record is different than that of applcant,indicate below. the property in question:Annually Assessed
Meal Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sZ
i (=CIA
Address of mortgagee or contract 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
other applicant own property in any If yes,what coup • i requested If yes,state amount d deduction
in Indiana? ❑Yes ❑No
Drawer �' v l s. ❑No
• A person is not entitled to this deduction unless tl • ••• ••...I.......,• cl indebtedness that is recorded in the county
recorder's office(including any home equity line i I s the basis for the deduction.
Card NO.
Deduction approved in the amount of ••••..l'(
20 20 20 20 cam_ 20 20
Signature of County Auditor County Date(month,day,yew)
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.
Signature(soy m ) Date year)/217A(`
Full / t m atreet city,date,and LP e)
, t
%.fleenvel ,?7 7 •
P authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 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.