HomeMy WebLinkAboutMortgage_McClellan (4) ,psT. � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E'{'= FOR DEDUCTION FROM ASSESSED VALUATION
' Stab;Form 43709(R13/1415)
Prescribed by Department of Local Government Finance
•
INSTRUCTIONS: Fite Mark
To be filed in person or by mail. •
rm fired with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduce tpr�,1
Must be filed or postmarked with the County Auditor or County Recorder of the county Jere - ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Au d. agur)ly,)Q
where the property is located during the twelve(12)months before March 31 of each year the r.NsdJ§hY
See reverse side for additional instructions and qualiifcations.
Applicant(own�see on reverse sloe
Taxing Distract tuber! plan GIbSUN COi:�Racbrdncumtie OP enumber
- 11-08- Ybo- DOI,as9oa1 it "Ial
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessr ent date,anent year date ofipplication� legal or equitable owner?
ta
S wn❑ Yes ❑ No
ii exact no,what is his I her ct share of interest? If owned with someone other than spmrw,imitate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑ AnnualtyAssessed
• 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 run Wage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,what county? 1 What Taxing District? Has this deduction been requested If yes,state amount of deduction
otter county on property for
in Indiana? ❑Yes ❑No aurant.vran—❑Yns. ❑No _
A person is not entitled to this deduction unless x indebtedness that is recorded in the county
recorder's office(including any home equity tine ry C'y1/4.30 yCe. ACC-,LII CAP-- ;the basis for the deduction-
Deduction approved in the amount ob
-to oN b 2- 2a 1�
20 20_ '- -00 cg. ` �D ' 20 20
Signature of County Auditor Date(month,day.year)
I
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.
g ir lug namely, ^A Date(month,day,year)
F . 'Kache.of t umber and street state,and ZI P codeL h n /� L171965-
0 2.045 S I O SD l t) l/CJI JI!pIX.CJI/ /!'/'l 1,
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 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. .