HomeMy WebLinkAboutMortgage_Halbig (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
'' ; 1 FOR DEDUCTION FROM ASSESSED VALUATION
- State Form 43709(R13/10-15)
"---- Prescribed by Department of Local Government Finance MI
-
'k INSTRUCTIONS: F/ 't 1
To be filed in person or by mail �-1 r —. �"�;with:
Filing Oates 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 propieffy3 s 1 2 41E County Auditor
located on or before January 5 of the immediately succeeding calendar 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 March 31 of each year the i�,}� •i
See reverse side for additional instructions and qualifications. 0 }J01F`•. ,• 'MC
GI__&014 �OU1V7'f AUDITOR
Applicant .. : or contract buyer-see - on side) ,. Page e�number
er
in-cLt - ,16 — /0,-) _ )) - -//3 o -o, o, 7d-‘ -0�8
Assessed value of real property as of Mortgage/Corarad indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,areal year date of application legal or equtable owner?
/02, 8� 8 af) :,L-- ❑ Yes ❑ No
If no,what is his I her exact share of interest? If wined with someone other thran spouse,indicate with whom
If name on record is different than that of applicant indisate below. Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
1 Noble Home(IC 6-1.1-7)
Name of mortgagee or contract seller /��/
Address of mortgagee or contract seller number a city,state,a� .
Name of assignee or other ovmer 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 in Indiana? ❑Yes ❑No current year?.for ❑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/contract buyer of the aforementioned property on date application is filed.
kSignatur nname) Date(month,day,year)
Full resident address of appricnt(number and street,city.sate,arid'LP ode)
71(0 4 ivuri,Ci)1/ ri`ti_ya-ce_le xJ Y 7 (0 70
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 street city,slate,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. .