HomeMy WebLinkAboutMortgage_Day (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
"Ir.
FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R13/10-15)
Presorted by Department of Local Government Finance - O
Fe yy y
INSTRUCTIONS: •To be filed in person or by mail.
•
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propertyy 2 Fin$ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. u
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is -ght
See reverse side for additional instructions and qualifications. ri •. —IOW,'
Applicant(owner tract buyer-see Intl n on relerne side) ,GIBS ON COUNTY AUDITOR
Taxing District Key nu Read Page number
13-(3-` OR- ODD. &)b-001 R I317J1
Assessed value of real property as of Mortgage I Conrad indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant Hte sole •
assessment date,anent year assessment dale,current year date of application legal or equitable owner?
5 0 yes ❑ No
If no,what is his/her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate belwr Is the property it question:Annually Assessed
0 Real Property ❑ AnnuallyAsssessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
q A n ^ ^
IJS.!'l r I I
Address of mortgagee or contract seller(number and street rdy,state,and ZIP co`dee)),, —it Name of assignee or other owner or holder of mortgage �cy o—ki\ VIII O
Address of a �v'C tcl`o w' bc3.-- \
ssignee(number and street,city,state,and
Does applicant own property in any If yes,what count l u 1 peen requested If yes,state amount of deduction
otter i bWiana?ly ❑yes ❑No 4"R `� aJ1�V1s \ l Yes- El No
A person is not entitled to this deduction unless tin had indebtedness that is recorded in the county.
recorder's office(including any home equity line on,.mu,u,a,'C,a~wou,,,um wu,ny,c,,wvc,a unrwl 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.
S' $name Date(month,day.year)
Fun r " address of applicant(dither and street,oily.state.and DP code)
/f& S 3rd 4ve , 64k Coy 2.A/ LI7C O
P authorized by duly executed Power of Attorney or by IC s-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street rdy,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.
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