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HomeMy WebLinkAboutMortgage_Edwards at STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year ;- FOR DEDUCTION FROM ASSESSED VALUATION �' State Form 43709(R13/10-15) Presorted by Department of Local GovemmeM Finance INSTRUCTIONS: File Mark To be filed in person or by mail. SE. of Set ft Filing Dates: 1) Real Properly.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. ecerder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county where the properly is located during Me twelve(12)months before March 31 of each year the deductionateggliN CUu JIY AUUl10R See reverse side for additional instructions and qualifications.rsd q ,A i F al it Taxing District Key number/mall description 4 ( /�'L'(1�11 Record nL i.-r Page number 33 Assessed value of real p�upexty as of at, Mortgage 'a dn O OW as of©IMMortgage/Contract VMedn03s unpaid as of Y Is the applicant essole assessment date,aurrerd year assessment date,current year I date of application legal or equitaA�e owner? S I i QlD ❑ Yes 0 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 afferent than that of applicant indicate below.. Is the property in question:Annually Acted ❑Real Property 0 Annually Assessed • Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Address of mortgagee or contract seller(number and street cdy,state,and ZIP code) Name of assignee or other owner or holder of mortgage _ - - • Address of assignee(number and covet dryy,state,and LP ©NO Does applicant own property in any If yes,what county? Drawer NO'' �............. quested If yes,state amount of deduction other county in Indiana? ❑Yes El No 3o0 ❑No A person is not entitled to this deduction unless the per Card N O. ....................• debtedness that is recorded in the county recorder's office(including any home equity line of arc a basis for the deduction. ‘45:2146. al Deduction approved in the amount ot. 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 coned and that the applicant is a resident of Indiana and owner contract buyer of the aforementionedti property on date application is filed. • nature owner's tut �/ �� Date(month,day,year) • ZIP F .3 address � ALauthorized by duty executed P Power � IC�,, IC . 1/14. x.e>MI2 , & 7(month,day4 7o 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.