HomeMy WebLinkAboutMortgage_Mason (14) �,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Yt , FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 1 10-15)
- Prescribed by Department of Local Government Finance FIT a E
INSTRUCTIONS:
File Mark
To be filed in person or by mail. AU Fdnnhlat',M$_
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 ❑ Cou Auditor
located on or before January 5 of the immediately succeeding calendar year. ��t
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th n f� H Recorder
where the property is located during the twelve(12)months before March 31 of each year the de�i<Kho 7�C -i.,,;.:J Cf i OR
See reverse side for additional instructions and quafficalions.
Applicant(owner or contras buyer-see resuicdons on reverse side)
r J CLAv.c--, E -4-- can't c e c, MaSetn
T A g District Key number/legal description Record Page number
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Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cured year assessment date,current year date of application legal or equitabJa owner?CC)0f 1.1–d.'1(es ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,radiate with whom
If name on record is different than that of applicant indicate below. Is the property in question Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
• Mobile Horne(IC 6-1.1-7)
Name of mortgagee or con seller
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Address of mortgagee or contract seller(number and treat city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage .
Address of assignee(number and street,cry;state,and ZIP on �//l//
•Does applicant own property in any If yes,what county? / O /�/ gad If yes,state amount of deduction
in Indiana? ❑Yes ❑No Drawer 1NO,,..L..... `a...... INo
A person is not entitled fo this deduction unless the,per. 2 btedness that is recorded in the county
recorders office(including any home equity line of men Card \' 3/ J teals for the deduction.
. . ........
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.
,Signatu (owner full name) Date month,day,year)
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d . ,a:7– of a ber and street,city,slat: nd ZIP code
\-10C) Ca-I-cceN`,3coz- t . �rr:f r\ce \Qnt 4 - -X1 nil
Person authorized by duly executed Power of Attorney or by IC 61.1-12-04 Date(month,day,year)
Address of authorized person (number and sheet city,stale,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.