HomeMy WebLinkAboutMortgage_Dearing (2) x STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
or- FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
<-P Prescnbed by Depambrrcr4 of local Government Finance
INSTRUCTIONS: aFile Mark
i be filDad in: )rson by mail P
Filing Dales: 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 pro ? i l,,j Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile I 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 sot rp 1 7 -n 18
See reverse side for additional ins(mctions and qua!lfications.
AppfiCarS(bt er or wcreC buyer-See icUmhi revere sde)1 a - It
PS In f'.4- - L. e-ac—k r\ T p
TaringD ct Key number! GIB d 1 ° .Pageiuimber
c-anc h I a ate 1 -l - I Ca - co l. - s 8 Oc 2n t 2'÷q h •
AssesseDvalue of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
currentassess assessment date,currentyear assessment date,current year date of application /� r. ) legal oreequimbt owner?
ea, 1lo ofn - P.M—es ❑ No
If no,what is ids l 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,indica below. I Is the property in question:Annually Aesr•6ed
�oig ) 797 — '
Name of ee co nbact`
ks Can Q Q�-n & Drawer NO —
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage Card NO. .
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Hz ]eduction been requested I If yes,state amount of deduct •
other county on ' .'ty for �� r'�.,
in Indiana? ❑yes El No curet 1n Ll -
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or a as that is recorded in the county
recorder's office(including any home equity fine of credit that is recorded in the county recorder's office, ; .{ib:•.,.: .ais-Ur 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 coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is tiled.
Sig (ormets full name) ye
F of t(nu ,dsln'^t il};Statt,' cl + • E. \ -1. , 'e1 IL� A
Person authorized by duly ex of Niamey or oy t�o-,. -,...,.. 7 ? Date(month,day.YEA
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 S 10,000.