HomeMy WebLinkAboutMortgage_Fetcher (6) t a STATEMENTFORDEDUCTIO OF N MORTGAGE ESS OR CONTRACTEDVALUATION INDEBTEDNESS Cou Township Year
Step Form 43709(R13/ � -
� PrescribedPresed by Department of local Government Finance
INSTRUCTIONS: �`..
To be filed in person or by mail. No Form fi.>''t it
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 ty Auditor
boated 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 .-..
where the properly is boated during the twelve(12)months before March 31 of each year the deduction ' •c,24 ti,,g4.; .
See reverse side for additional instructions and qualifications. `//JIL/,, y/�////� / NTH
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tt/G� A gZ J l o os- E0o7A9- 0a0 lip number PI
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Assessed value real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment data,orchard year assessment dap,current year date of application Oil legal or equitable owner?
/a2 9,55), ❑ Yes El No
If ro r
,what is his I her exact share of interest? If awned with someone othe spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
Real Property ❑ AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ( 44
Address of mortgagee or contract seller(number and street, . , ,and ZIP code)
Name of assignee or other owner or holder of mortgage / it 44
ki9OQ d hx /L 2^�/, l
OF ' S o O
Address of assignee(number and street city,state and ZI-,..4e)
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 in Indiana?n ❑yes ❑No currrent on p�year?for ❑yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortydgu or contact indebtedness that is recorded in the county
recorders 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: — — — _________ti
20 20 20 20
Signature of County Audio _
Carrimfri lY7ori a-s
I/We certify under the penalty of perjury that the above and foregoing iri
owner/contract buyer of the aforementioned property on date appticatia S.,'V,A.�-
y 3
Signature(owner'sUJ tuff name) r-� l
X t
( ( IO, 3-4— ,'I A,k.
Full resident add of applicant(number and street city,sate,and e /�C2 1 9 3 . 6-0
1\ aou Kock /2d tau 4'Iudie .a--,A) y`
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7
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. _ -
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