HomeMy WebLinkAboutMortgage_Bralley STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R13/10-15)
Presatbed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 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 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
A \ant
• ner or contra see restrictions oi3rersrs'e_y`d'1) �\
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Assessed value of real proper as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedne s npaid as of Is the applicant the sole
assessment date,amend year assessment date,current year date of app! legal or equitable own e .
O — • ❑ Yes ❑ No
If no,what is his t her exact share of interest? If owned with ne other than cruse,indicate with whom
If name on record is different than that of apptment radiate below: is property in question:Annually Assessed
Real An of Assessed
Name of mortgagee or contract seller
i
Address of mortgagee or contract seler(numt AUG 1 3 2018 \/
Name of assignee or or owner or holder at Drawer NO.2U ` ()
Address of assignee(number and street city, SON ry R
Card NO 31.3
Does applicant own in any If es, ''''•'•'"'•''•• ction been requested If yes,state amount ofdeduction
property Y Y
other county ..... s
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
recorder's 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,yea)
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 t contract buyer of the aforementioned property on date application is filed.
c!& & wa name/ - Date(month,day,year)
addres s of r and street.ah;sra�.pnoL code)
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4r
Person authorized by duly executed Pomfret Attorney or by IC 6-1.1-12 / Date(month,day,year)
Address of authorized person (number and sheet 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.