HomeMy WebLinkAboutMortgage_Bingham o STATEMENT OF MORTGAGE OR CONTRACT IND NS Township Year
iA FOR DEDUCTION FROM ASSESSED VALUATION
?�( ,,+ State Form 43709(R1216-14)
' ,•e' Prescribed by Department of Local Government Finance A 20`8
INSTRUCTIONS: MAR Y File Mark
To be filed in person or by mail. Form filed with:
Filing Dales: 1) Real Property:Must be completed and dated in the calendar year for which the d-• ction i,-•:•d! .
Must be filed or postmarked with the County Auditor or County Recorder of the • . .r!?t' �:
y y ff i7 .osFrri62 ❑ County Auditor d .
located on or before January 5 of the immediately succeeding calendar year. C p11NTY L t r ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file r4_Q wC Auditor of the county
where the property is located during the twelve(12)months before March 31 of each V year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
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Taxing District Key number/legal description Record number Page number
aL9- la- nq - IoLi - 000. I8 - 0a-1 a° t - to.-3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
ra S, 000. On [x}'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 appficanl,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 `t�
2Vf1inc T
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,slate,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 on property for
in Indiana? R
Yes No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a ba lance 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 pe iffy that the above and foregoing informa''n is true and correct and that the applicant is a resident of Indiana and
D ner/ ntr acLbuyecof the aft)/-me honed property on date a•pe -lion is fil:..
Sic ( s a Date(month,day,year)
Full resident address of appf t(number-sr street,city,state.and ZIP code)
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Person authorized by duly executed Pow: of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street,city,stale,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.
I.