HomeMy WebLinkAboutMortgage_Jones � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION gg��
=' =' State Form 43709(R13/10-15)
-;_-- Presamed by Department of Local Government Hnance tt
INSTRUCTIONS: •
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To be filed in person or by mail. DEC b O LUIr
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 when:the property is ❑ County Auditor
boated on or before January 5 of the immediately succeeding calendar year. corder
where 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cou
where the properly is boated during the twelve(12)months before March 31 of each year the deducety.se' OUNTY AUDITOR
See reverse side for additional instructions and qualifications.
AppSnnt(ownd. contract b10er- des on )
Tama- Ii'. Key number/ .. �'�.-pow) Record nun r e nurtgbe
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value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant ihe sole
assessment date,current year assessment data,anent year date of application legal or equitable owner?
/CO cap ❑ Yes ❑ No
If no what is his/her exact sham of interest? If coned with someone other than spouse,indicate with whom
If name on record is•,i--m than that of applicant,indicate below. is in question:Annually Assessed
///J -{J Ls Property ❑ MnuallyAssessed
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Mobile Home(IC 6-1.1-7)
Nacre of mortgagee., ... ... - r
Address of mortgagee or contract seller num and sheet ,stat^e,and ZIP code)
Name of assignee or other owner I,' of mwfgag� , / /� oz" r �-1� / /_2- /1 ' e g�
Address of assignee(number an'street4C6^state,/and LPcodeee))/ Y/ (/1/ /`J
Does applicant own property in any If yes,what county? 1Miat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county in Indiana? ❑Yes ❑No acomenp`nt ear? ❑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.
I COUNTY AUDITOR
Deduction approved in the ancunt of
20 20 20 20 20 20 20
Signature of County Auditor County - •Date(month,day,year)
I 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 tiled.
nature(onwne^rs_full Date(month,day,year)
Fug " �of app• (number and street city.state,and VP code)
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gv 9(0 t s R 107) (Fxi Gcicon(k G-k� Y)( 640
Person authorized by duty executed Pourer of Attorney or by IC&1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city:stare,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. - -- - - —'-