HomeMy WebLinkAboutMortgage_Wilson (9) 'r#: ra FOR DEDUCTION FROM ASSESSED VALUATION INDEBTEDNESS County Township Year
� '' State Form 43709(R13110-15)
�- Prescnbed by Department of Local Government Finance
INSTRUCTIONS: _
lb be filed in person or by mail fled
Filing Oates 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 where the property is J / County
located on or before January 5 of the immediately succeeding calendar year. ecord
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county ��btyJ� er
where the property is located during the(why(12)months before March 31 of each year the deduction is so
See reverse side for additional instructions /J 0/ '
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Twin. •.• / Key number/legal description Record number Page nuir{bl.*
u)tt, I�6- g- 146-/Co-90.3 0/ 7- 6d/ -. 201t 23- 11
444ec ::value of real property as of Mortgage t Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
rtes,ainerd year assessment date,current year date of a�p ' nn legal or equi�Me owner?
❑ Yes ❑ No
If no,what is his/her exact share of brterest? If owned with someone other than cpnucn,indicate with whom
If name on record is different than that of applicant,indicate below: ` I�s property in question:Annually Assessed
yj 'Real Property ❑ AnnuallyAssessed
• //��/� �,,. IIIIII'''"'��`��` Mobile Home(IC 6-1.1-7)
Name of mortgagee or marred seller 73...../. r /) /�.�WrCl'- ( �!`4'
Address of mortgagee or contract seller(number and sheet!/pry,state,and ZIP code) - - -
Name of assignee or other owner or holder of mortgage /11 I C/' —
Address of assignee(number and sheet city,state,and ZIP code) Drawer �'O^/ U 11• i/^
Does applicant own properly in any If yes,what county? Vdnat Taxing District? Has th Card N O. 21- I I
other county on pro
in Indiana? ❑Yes ❑No anen _
A person is not entitled to this deduction unless the person has a balance on the person's mort_ .
recorders 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
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 coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's trot_ Date(month,day,year)
F �T�
F' tln�d appficm(nu and s5eet ary,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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.