HomeMy WebLinkAboutMortgage_Dellinger (2) ,,.,r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
?:. State Form 43709(R13/10-15)
<--- Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Marie/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
Mere the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
FILED writraciell Taxcmg Districk numb, legal descri .b 9 Record number a Page
-i - o�i°-3-�ba D JAN Ors 2018
Assessed value of real property as of Mortgage t Contract indebtedness unpaid as of Mortgage/Conrad indebtedness unpaid as of Is the applicant the sole
assessment date,current year assesunem date,current year of applxaron legal or equitable owner?
r Y 71A • Yes ❑ No
dno.what is his/her exact stare of interest? a owned with someone other than 6 ;.� i it "� *AUDITOR
H name on record is deferent than that of applicant,indicate below: Is the property in question:Annually Assessed
.-------) ❑ Real Property ❑ Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or=tract seller Cg)SL
Address of mortgagee or contract setter(number and sheet city,state nd ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any H yes,what county? Mat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property❑Yes ❑No current 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
recorders 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
20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
1/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 b er of the aforementioned.property on date application is filed.
7: Date(month,day,Yeah
Full resident ad appfipn cumber and street city,state,and ZIP code)
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet d0: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.