HomeMy WebLinkAboutMortgage_Tooley 6,Hilz__.7:ith STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
• State Fonn 43709(R13110-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: • File Mark
Filing be filed in person Real l by mail. IlortJl fi�d i/.
To be Dates 1) Rear Property-.Must be completed and dated in the calendar year for which the deduction is sought �y
Must be filed or postmarked with the County Auditor or County Recorder of the county where the Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coµfl y ci �IR curly Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is t
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer a restrigiqns on reverse side)
attear- Ni- Ve• d' • • • Q c� dieu t afrear
Taring District number I legal description C CilritgfprliggrY AL pQ,i,
a 3it-Qoo-ooa.211-tea I "a6j Assessed value of reaf property as of ortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year data of application legal or equitable owner?
3 Is br05t) ❑ 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 augment,indicate belwr Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
• Mobile Nome 00 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state ZIP code)
53
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? VMTat Taxing District? Has this deduction been requested If yes,state amount of deduction •
other
in iana? ❑Yes 0 N anent rfT o ❑Yes- ❑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
recorders office(including any home equity line of credit that is recorded in the county recorders 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 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 I••ntract b or of the :•rementio :• property on date application is filed.
7mu lip s fur. a,;,- Date(month,day,year)
address t.. cant(nu,... and street city,slate,and ZIP code)
, .I $ 5 ti !•arcear- i4- {-�&4 Q - .Qt 4 703 9
erson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Data(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$10,000. - .