HomeMy WebLinkAboutMortgage_Akers } . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
S' = FOR DEDUCTION FROM ASSESSED VALUATION
-----_F 'f-2^ State Form 43709(R13/10-15)
�— Prescnbed by Department of Local Government Finance
INSTRUCTIONS: - File Mark
To be filed in person or by mail.
Filing Dates: 1) Real property:Must be completed and dated in the calendar year for which the deduction is sought $p
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prope e Itptv-
yri.D'i itor
located on or before January 5 of the immediately succeeding calendar year: gggggg JL i + County Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is/orated during the twelve(12)months before March 31 of each year the deduction is sought,I N 1 2018
See reverse side for additional instructions and qualifications. J U
App&an : or contract buyer--=.-. o• -verse side)
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Taxing District - number/legal d
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I 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?
_2 C ri b ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
tf name on record is different than that of applicant indicate below. Is the property in question:Annually Assessed
❑Real Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
513
Address of mortgagee or contract seller(number
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Name of assignee or other owner or holder c fm ` A.°. LS "keys Ttj s
Address of assignee(number and street dry,s v`� j Q )O Q(l , loO ((�
Does applicant own property in any If yes,wna.w.... I _ ` `I" tuition been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No I [current year? ❑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/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.
cgrWU full name) / Data(month,day,
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Fullr �tlress of (um and street state,and code)
/1I `/(a��/�°t � , , 4 7 c0 1 v
Person authorized by duly executed Power of Attorney or by IC 6-1A-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$10,000.