HomeMy WebLinkAboutMortgage_Deckard (2) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year uFOR DEDUCTION FROM ASSESSED VALUATION F ILE i 1�
State Form 43709(R73l70.15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: .. File MaI.
ys
To be filed in person or by mail OCT
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 A : •• •uditor
located on or before January 5 of the immediately succeeding calendar year. t., a 412014 mtyy Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co wr4 i, O 1 , •UDITOR
where the property each is located during the twelve(12)months before March 31 of ea year the deduct• ::7.•
See reverse side for additional instructions and qualifications.
App5rant jar or contract buyer-see restrictions on reverse side)
J e Qnn\ ne $ T)e-UL.Qrd .
T g District number/legal d Record n n r
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1
Asseccy value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicailade
assessment date,aurem year assessment date,current year date of application W legal or equitaa'e ownowner?t 0DSO. ❑ Yes ❑ No
di
If no,what is his!her exact share of interest? If owned with someone other than swamp,indicate with whom h
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
0 Real Property 0 AnnuallyAssessed
Mobge Home(IC 6-1.1-7)
Name of mo ee or contract seller
Address of mortgagee or contract seller(number and abeet city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ID No 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 or:
20 20 20 20 20 20 20
Signature of County Auditor ennnty - 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 (owner's fun name) Date(month,day,year)
a -1-- 1 Q -3 1 -12
F r address of applcan (nun, and street,city,state,and ZIP oRde t j,
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12.0.7 t l bate(month,day,year)
Address of authorized person (number and street city,state,and ZIP aide)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.