HomeMy WebLinkAboutMortgage_Yeryar (2) - STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•E"f'° FOR DEDUCTION FROM ASSESSED VALUATION �J j p
State Fonn 43709(R13/10-15) g
Prescribed by Department of Local Government Finance
eds per d
C idFo th-
INSTRUCTIONS:
person or by mail.
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 Reuonter of the county where the property is 1E1 . ❑ 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 a1Mailtip, unty Recorder
where the property is :•dung the h+e/ve(12)months before March 31 of each year the deduction is sought rv�.,�J(1 OR
See reverse for additional in.• .1• •qualifications.
Applicant(• contract buyer-see - -• •.,on reverse side)•
r'Y Key •- /— Reco d1 Jm��h7er number
Assessed value of r � ort0 age indebtedness�6onpaX /r�Contract indebtedness unpaid as of Is the applicant��
assessment date,current year assessment dale,cement year date of application • legal or equitable owner?
9.50. COD ❑ 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 different than that of applicant indicate below: Is e property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller / dZ•
Address of mortgagee or contract ear(number and sleet city,stile,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and -•= `;)..r,state." •DP code) / yke /I at•
Does applicant awn property in any •e what county? What Taxing District? this deduction been requested If yes,state amount of deduction
'nnIM county ❑Yes ❑No acemennt bra? ❑Yes. ❑No
A person is not entrIled to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorders 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 informations 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.
Sig (owner's tut name) Date(month,day,year)
Full ItJcta•.' m��L�r !t /YP ) 4 � /Ui0 !Y/� I /(!�< `�
Person authorized by duly executed�f 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 S10,000.