HomeMy WebLinkAboutMortgage_Page STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN •
clit ; FOR DEDUCTION FROM ASSESSED VALUATION =Qf�4'?�Tan A.LN p Year
,., ;, HO lane >lrinOO oselD
State Form 43709(R13/10-15)
prescribed by Department of Local Government Finance A a I I • 464_. I!
INSTRUCTIONS: ,1 File Mark
To be Oates in person or by mail o l i Eorm Eer i f�
Filing Oates 1) Real Property Must be completed and dated in the calendar year for whirr the did �µ� �'
Must be filed or postmarked with the County Auditor or County Recorder of the aini i terE rt$d DITO' ❑ 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 of the co .`f Olt -. ',-•I oiler
where the property is located during the twelve(12)months before March 31 of each year the deduction is so i • —.
See reverse side for additional instructions and qualifications.
t(owner or contract see restrictions on reve side).51
Taxing District ) Key number!legal description Record number Page number
' �,, e. lei-b2-4 oD r- boa. a 4 - o 3-1 a. 0 rl a (09 1
value of property as Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date, year assessment dale,cement year date of application legal or equitable owner?
a. to tic( Yes ❑ No
If no,what is his!her exact stave of interest? ) If owned with someone other than spouse,indicate with whom
If none an record is different than that of applicant,indicate belaw I lithe property in question:Annually Assessed
Nola,ROperty_fl_Ann:ypy (IC ,.,-7)
Name of mortgagee or contract seller - -
D fro "
Address of rmnga or contract'
seller(number and sheet city,state,and ZIP ante) t 0•.. ••
Drawer Name of assignee or other owner or holder of mortgage •U.1.-{•.
Address of assignee(number and street,city;state,and ZIP code)
Card NO. ..... .1
Does applicant own property in any If yes,what county? What Taxing District? I Has this deduction been requested If yes,state amount of deduction
other county lr��77'�'� on property for
in Indiana? ❑Yes nsprr0 , aurent year? ❑Yes o
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(induding 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 0rementione pert),on date application is filed-
����iiyyfu��g,,,,..""me) Date(mmtlr,day,year)
resberxtTtldress of applicant(nnuumpet and street, sae,and ZIP code)
? J5'9 Harreq lame ov )le,I
N . *71 ,5
P
authorized by duty d 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 510,000-