HomeMy WebLinkAboutMortgage_Mossberger (2) s, FOR DEDUC IO MORTGAGE S ED ALUAT INDEBTEDNESS Township Year
'� � FOR DEDUCTION FROM ASSESSED VALUATION
')'' State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
bINSTRUCTIONS:
filed in perrson or by man. MAR 1 3 2018 File Mark
To Font filed with:
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which She deduction is sought ❑ County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county whe a pro.pan ■J
located on or before January 5 of the immediately succeeding calendar year. wt i�' 9'
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Au.1 i1'1�ii�: .,1dtf¢UD(T O® County Recorder
where the property is located during the twelve(12)months before March 31 of each ,::.:; t.. is sought —
See reverse side for additional instructions and qualifications.
Appbcant�or contract buyer-see restrictions on reverse side) n/um�ha/r SJ.
• g District )Key number/legal Record 79 a � Dbs
a6-(o -a6 -900..- 000, 055'_ o J-i C�i/
Assessed of real property of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the the sole
assessment current year assessment date,current year date of application legal or equitable owner?
/57 ,t0O ❑ yes ❑ No
If rro,what is his I her elect share of interest? If owned with someone'ther than spouse,indicate with whom
If name on record S different than that of applicant,indicate below. Is the properly in question:Annually Assessed
❑ Real Property ❑ AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller S/ ^ �✓y/�J�'�
Address of mortgagee or contra seler(number and sheen crt�,ktate,and ZIP code) •contract
Name of assignee or other owner or holder of mortgage I�
Address of assignee(number and street city state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing Disfict? Has this deduction been requested If yes,state amount of deduction
other county , property for
in Indiana? Yes 0 No current year? ❑Yes• 0 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.
X/// Signature( name) .. Date(month,day,year)
y
Full resident of applicant(number and street city,state,and ZIP code)
/ (o 65 O O IA) 4 S A / Y�� � .
Person authorized by duly executed Power of they or by IC 6-1.1-12-0.7 Data(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 S10,000.