HomeMy WebLinkAboutMortgage_Bradebourg toec , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. ''= n FOR DEDUCTION FROM ASSESSED VALUATION
�'� State form 43709(R13 f 10-15) ��- - Presrnbed by Department of local Govemmenl Finance
INSTRUCTIONS:
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lb be filed in person or by mail. J U n Fgn ttl� h:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought '1 J
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. tyi2eborder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coup
where the property is located during the twelve 02)months before March 31 of each year the deductioofb COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) q
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Ting . Key o all -co� . lai - 0 th rn \y �g number _
Assessed value of real property Sof Matyeye/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment data anent year date of application tion cin legal or equitable owner?
1 Q v nI (000.� - ID Yes ❑ No
Ir no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on ream]is(efferent than that of applicant indicate bebvr Is in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-11-7)
Na of mortgagee or"tract serrller - cC — l t aJ-Qt
�YNle.c rn�.ct.
Address of mortgagee omcontaact seller(number and street city ter tJode),`-j}r
Name of assignee or other owner or holder of mortgage
8-r l--0C- ( of I 1 y QS f1e/s.oT)
Address of assignee(number and street city state,and ZIP code) Q, KE` k
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Does applicant own property in any If yes,what county? What Taxing District? on Has this deduclic property `l.p \cwwk S*o to M o A J c1-71 e J
in Indiana? ❑Yes ❑No atrent year? I 4 /I
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or o ( \ V. b • D O
recorder's office(including any home equity line of credit that is recorded in the county recorder's office) ( �D.7('
COUNTY AUDITOR '-b `Ll-49 L1
Deduction approved in the amount of
20 20 20 20 20 20 - 20
Signature of County Auditor County • Data(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 fled.
Signature(owners full named Date(month,day,year)
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Full resident address of applicant(number and street,city,state, -w-code)
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X Person authorized by duly executed Power of Aboney or by IC 5-1.1-12-0.7 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 S10,000.