HomeMy WebLinkAboutMortgage_Wilkerson (16) }, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
• f' State Form 43709(R13/10-15)
"`i Prescribed by Department of Local Government Finance
INSTRUCTIONS: • File Mark
lb be filed in person or by mail. Form filed with:
Fling Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orposbnarked 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 cakmdar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county ❑ County Recorder
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner contract buyer-see restrictions.. reverse side)
Taxing District � " Key number/legal •es—Li o a_ 001 .60j _ Dag Record nwnper Page number•
Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
acceccnent date,current year assessment date,current year date of application legal or equitable owner?
❑ Yes ❑ No
C no.what is his/her exact sham of interest? If owned with someone other than wan.,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
�` ❑ Real Property ❑ AnnuafyAssessed•
"""��� Mobile Home(IC 61.1-7)
Name of mortgagee or contract sellrl/ ll
0 lat.:11
1 J
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 dry,state,and— - .-
Does applicant own property in any N yes,what count 0`//�/ uested If yes,state amount of deduction
��? ❑yes 0 N Drawer NO...r.-«Q.�.� ID No
—
• A person is not entitled to this deduction unless the lebtedness that is recorded in the county
recorder's office(induding any home equity line of ,basis for the deduction.
Card NO.
Deduction approved in the amount of
20_ 20_ 20 20 20 20 20
Signature of County Auditor County • Date(month,day,yea')
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is tiled.
Signature(owner's full name) Date(u.wrdr,day,year)
•
F resident I-e�of cant(n'um)ber city,state,and ZIP code)
NSNr�3 d byd7 axe Ff/.�f!'7
cried by duly executed Power Attorney or by IC 6-1.1-12-0.7 Data(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.