HomeMy WebLinkAboutMortgage_Fuesting ss STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou 1�iZ,�ftt l��
FOR DEDUCTION FROM ASSESSED VALUATION x
'` State Form 43709(R13/10-15) .'
Prescribed by Department of Local Government Finance � �
INSTRUCTIONS: • '6'"'�'�Qj�
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 •
Must be filed or postmarked with the County Auditor or County Recorder of the county where the,lep t C "• verni f u • ditor
located on or before January 5 of the immediately succeeding calendar year. ' COUN
2) Mobile/Manufactured Homes not assessed as Real Property:Must No with the County Auditor of the county i''���`URrder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse /fc�oorn/a�dddditional instructions and qualifications.
•
Appl�nt( gc7 r ! Ilnaoot.([. a) �:9J '/
Tadif I / /N -/f-,56.-„goo-0 D 0..0; 9-O 57 Record number Pa�ge/n�^ber
".value of real as V~s' rt �id / �tesj
.-- J 1 daM, year rentrrtear indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the or rtt e o n e
application legal w eW owners
/g451 ❑ 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 deferent than that of appfaant,indicate below. is propety in question:Annually Assessed
+Dl Real Property ❑ Annually Assessed
•Name of mortgagee or contras seller a1 /Q ij2e
P Mobile Home(IC 6-1.1-7)
Address of mortgagee or contract seller(number and° tsrnnnEJ'�state,,aand ZIP code)
Name of assignee or other owner or '!`� N /(! / / / r ,/'1� /�
Address of assignee(number and state,and LP code) /
Does applicant own property in any If yes,what county? % hat Taxing District? Has this deduction been requested If yes,stare amount of deduction
other ProPertY fix
Indiana? ❑Yes ❑No anent
year? ❑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 that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of-.
It D.\2 P N:L,_e SA-'I v■cl °F i.Q.-AA- S.
20 20 P''‘�,..ZSA ∎,r.S Ao E. C� 20 20
Signature of County Auditor aC) `Th '�J). I Date(month,day,yea)
I i We certify under the penalty of pet � 'a3 l J O C (30 red and that the applicant is a resident of Indiana and
owner I contract buyer of the aforemeuu,n,ew.Y.,.,,...., .....__._ __.
e( „'roc Date(month,day,year)
N. all Y
Full resident address of (number an city,state, LP code)
1. ■c)3(a)\'-) � An1\Lin a1u ak+ TAB u7&W
Person authorized by duty of Attorney or by IC 51.1-12-0.7 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.