HomeMy WebLinkAboutMortgage_Hoskins } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County s Ip a
FOR DEDUCTION FROM ASSESSED VALUATION �J E
State Form 43709(R131 10-15)
�— Presalbed by Deparb ent of Local Government Finance
INSTRUCTIONS: .. FiIJa&rtr2 4 2018
lb be filed in person or by mail. .__. Form filed with:
Filing Oates 1) Real Property Must be completed and dated in the calendar year for which the deductfon is sought � ��(/��
Must be filed or postmarked with the County Auditor or County Recorder of the county whom the property is ',UUtr4 itch
located on or before January 5 of the immediately succeeding calendar year. GIBS O N ra tidy F2eimffer)R
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see resbkdrau on reverse side)
L.)1 ;‘ oar, G a S r c.rp vQr c t c. • -1 • V\OS IL.i r,S
Taxing District /� ,��t� Key number/ description 1`�'y`'-V'�'"� 1lU.. Record nu/mber Page number
Assessed value of real p a ill.J Mortgage/�indebtedness unpaid as 30— ()Contract indebtedness unpaid astir Is the ap�ggge
assessment date,current year assessment date,current year date appr ' legal or equitable owner?
LAW ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is the in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
_ Mobile Home(IC 6-1.1-7)
Name of Trtgagee or contract seller
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Address of mortgagee e ct or contra seller(number and stn D r a Wee NO
Name of assignee or other owner or holder of mortgage
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�• t∎kCCCS \y . Card NO. !lIJJJ `
Address of assignee(number and street city,state,and.
Does applicant can property in any If yes,what county? that Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? ❑
CI 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 m the county
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/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 contract buyer of the aforementioned property on date application is filed.
Signature(owner's -.,s h:. e) / Date(month,day,yea)
Full,resident address of app (number and street city,state,and VPoode /1 ,-, �Q` �.1`
ut Ou a 1 by S.0 Po rC 0 0 3\Set• i i- . ilrQ C v'1 . (month,daQan c
Address of authorized person (number and street oily,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.