HomeMy WebLinkAboutMortgage_Sandy ,f� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Comp Township Year
` =`tr" FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 esalbed by Depasrtment s
Pr of Local Government Finance �-
INSTRUCTIONS: MAY 9 2018 File Mark
To be filed in person or by mail. Form sled with:
Filing Dates: 1) Real Property.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 ere.the_rn.-4, •is � County Auditor
located on or before January 5 of the immediately succeeding calendar year. l .. �r
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with ttt�� er 1 t tOR ❑ County Recorder
where the property is located during the twelve(12)months before March 31 old=�' , : ' is sought
See reverse side for additional instructions and qualifications.
Applicant er or contraUpvyer-resale tans on reverse side)
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Taxing District Key number/Iey$description number Page numbar
Z&-/9 / /O / ctQ 9- 760 6 0/9 /S8
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
// 7$a ❑ yes 0 N
if no,what is his I her exact share of interest? If owned with someone other than spmxce,imitate with whom
If name on record is efferent than that of applicant,indicate below. Is the property in question:Annually Assessed
Property ❑ Annually Assessed
Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller "/
Address of mortgagee or contract seller(number and stmt,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,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 county on property for
in Indiana? ❑Yes ❑No - current year? ❑Yes [Iwo
A person is not citified 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
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DALE- 4. sittiDy
20 20 20_ 20 20
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Signature of County Auditor /V — Date(month,day,year)
I/We certify under the penalty of perjury that the abot applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property,,..
Signature/V: Date(month,day,year)
Fug a (number and sheet city,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-07 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$10,000.