HomeMy WebLinkAboutMortgage_Saliju a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
L` FOR DEDUCTION FROM ASSESSED VALUATION
State Fom143709(R13 t 10-15)
Prescnbed by Department of Local Government Finance ?�-
i NM MI
INSTRUCTIONS: • I : if
Tb be filed in person or by mail. Form filed wdh:
Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought n,,� ,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is JA ® $Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
El County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is • f , .pair
See reverse side for additional instructions and qua(ffcatbns.
CIDSON CD'JYTY AUD;TOR Appl'cant(owner or G@er-see pq non reverse ) -
Taxing District Key number^rr legal description^ _V /I .3 3 —000 'f 11 3_Cotx b Record rig Page
e- U� r
Assessed value of real property as of L.,�r1 tMorgaO gel/CoCormact indebtedness unpaid as of Mortgage/ ?Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year da appdg',ion/� legal or equitable avner?
OV ❑ Yes ❑ No
If no,what is his/her enact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant indicate below Is the property in question:Annually Assessed
❑Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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 city,state,am �� _ 1�
er �
�l
Vc-tr cc1iud 1 `br�v� So ` iJu
Does applicant own property m any If yes,what mur Q QC q . pueeted If yes,state amount of deduction
other in Indiana? ❑Yes ❑No —� l�d� ' 6U El No
A person is not entitled to this deduction unless ft ndebtedness that is recorded in the county
reowders office(including any home equity fine c �— fe basis for the deduction.
I:UUNI T AUDI IUK
Deduction approved in the amount of-
20 20 20 20 20 20 20
Signature of County Auditor County • Date(month,day.year)
•
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 1 contract buyer of the -1••rementioned property on date application is filed. �
Signature , e (urznuh.�LV f .
Full -td:ress.. -ii• ..: t(number- f street city:state.and ZIP code)
P+ on authorized by duly executed Power of Attorney or by IC e-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street etc 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.