HomeMy WebLinkAboutMortgage_Couts .: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
�l Stale Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
lb be filed in person or by mail ��ppggrr T „t ."
Fling Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sou ��w./ rat j ;
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is C •unty Auditor
located on or before January 5 of the immediately succeeding calendar year. �gp""��
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th�CWmrp — 21 tr County Recorder
where the property is located during the twelve 02)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. �rp.r
Applicant s on side) N.;j 1 iw fl
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Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,current year data T legal or equitatie owner?
DC) ❑ Yes ❑ No
If no,what is his/her end sham of interest? If owned with someone er than'ptuw,indicate with whom
If name on record is drfferent than that at applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
/ •1 iii - ` - —.
Address of mortgagee or contract seller(number and street dry,state,and ZIP code) ._ . — -
Name of assignee or other owner or holder of mortgage � /6P.
Drawer NO
Address of assignee(number and street city,sate,and LP code)
Does applicant own property in any If yes,what county? What Taxing Dish Card Q, Z7 mount of deduction
others arty
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on corded in the county
recorder's office(inducting any home equity line of credit that is recorded in the county recorders office)that is the basis for me aeuuuron.
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 off the aforementioned property on date application is filed.
Signature(��l�b�! �Y• e Date(month,day,year)
F t address of applicant(number and street,city,state,and ZIP code) `/
I id S {fair Sr• fQIMCelb•w/ fir✓ T i6 7°
P authorized by duly executed Power of Attorney a try iC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,sate,and LP code) -
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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