HomeMy WebLinkAboutMortgage_Franklin _sl STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County • Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
�t'' State Form 43709(R13/10-15)
<--is- Presrnbed by Department of Local Government Finance FILE ,
INSTRUCTIONS: • File Mark
To be filed in person or by mail D 40312W
Filing Dates: 1) Real Property 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 ❑ 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 the county , � Ill rmitri •ecorder
where the properly' located during the twelve(12)months before March 31 of each year the deduction 6::...960 •, i ' • • 1 1 • -
See reverse side for additional in thous uaffca(ons.
Applicant o earcontract d )o c-
Record 29l zoUkS a r7ibt 2 ota %
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage l Contract indebtedness unpaid as of Is the applicant the sole
assessment date,amend year assessment date,current year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If caned with someone other than spouse,indicate with whom
R name on record is different than that of applicant,indicate belaw is property hi question:Annually Assessed
Real Property ❑ Annually Assessed
• 7 , Moble Home(IC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seder(number and street city,state,and ZIP code) n r
Name of assignee or other owne fit.er' .e-'e
0 n, ; 41C, /-2-/o?.. ,a7-1-7n-'
Address of assignee(number and"yet city,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
imnIndiaana?y ❑Yes ❑No anent yeani ❑Yes- ❑No
• A person is not entitled to this deduction unless tin nay hoe a halanns on the cerson's morteaoe or contract indebtedness That is recorded in the county
recorders office(including any home equity tine. ,^,11 ;the basis for the deduction.
Deduction approved in the amount of Drawer N O..... V/..3^
20 20 Card NO. C160 ( 20 20
Signature of County Auditor Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing mrormauon m tom 4..— _.._that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
IN
Signature(owrmr5 fuH name /�(LT✓�r��'�� �.I �Tl��//1�/1(A`1' Date(month,day,year)
1 ufl resident address of applicant(number "and street city,state,and ZIP code)
Sorov, flit o,vo 0.sa.5..,lu-.J-A.. t)44 C
Person 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 thy,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. _ - - - - -- .