HomeMy WebLinkAboutMortgage_Wood s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court. Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
e}'? State Form 43709(R1311 0-15)
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Prescribed by Department of Local Government Finance �
INSTRUCT7ONS: zo 8 File Mark
To be filed in person or by mail. JAN 1 9 0 Form filed with:
Fifirg Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought ��Irrr���......,,,���
Must be filed or postmarked with the County Auditor or County Recorder of the ooun4 c where y.i;- is unty Auditor
located on or before January 5 of the immediately succeeding calendar year. .�i1ifih
2) Mobile/Manufactured Homes not assessed as Rea)Property:Must file with the Co 'I ) 4• -afi,¢Wl9R ' County Recorder
where the property is located during the twelve(12)months before March 31 B rthe. .. is sought
See reverse side for additional instructions and qualifications.
Applicant(owngtor c - res¢Ftions on reverse •' ) / 'lam I ����� /
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Key number 1 legal description le J .C_i(�_c.11/ number gfluumber
T� l./it -240- 4l0-i9.3C, can k57 0/ 7 bz5�
Assessed value of property as of Mortgage/Contract indebtedness unpaid as of Mortgage 1 Contract indebtedness unpaid as of Is the applicant e sole •
assessment date, year assessment date,anent year date of application legal or equitable owner?
❑ 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 afferent than that of applicant,indicate below. Iss thee property m question:Annually Assessed
I�cKeal Property ❑ Annua yAssessed
�n°. • / Mobile Home(IC 6-1.1-7)
Name of mortgagee or ' (41-4/7 yj_ "/� /1 1
Address of mortgagee or contac sellerr((nu11mbbberr/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 ZIP code)
Does applicant own property in any If yes.what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county property wx ? Yes ❑No current 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.
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 I contract buyer of the aforemention property on date application is filed.
Slg R/J Date(m Y.Yea')
It r ik90� Ir0
Full resident—dress of applicant(number and street city,state,and ZIP code)
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet 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.