HomeMy WebLinkAboutMortgage_Brown (10) „ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E r•_Y FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Presaibed by Department of Local Government Finance
INSTRUCTIONS: .. File Mark
To be filed in person or by mail. Form filed 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 CountyAuditor or County Recorder of the county where the property is ❑ County Auditor
located 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 of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Appfinnt(owner or cc4 -see •one on reverse side)
Taxing District Key mber �al0 r -1 V 1- aD 1- g 5 l —DQS R folo` r "g 2W
Assessed value of real property as of a Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,anent year date of�Ip legal or equitable owner?
I 1r 0 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than ywvrv,intricate with whom
If nacre on record is different than that of applicant,indicate below- Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
1f ] ] Mobile Home(IC 6-1.1-7)
Name of mortgagee 4contrant seller/ '(`�'-l�a
t
Address of mortgagee or contract seer(number L city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street 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
fOr
�iannan? ❑Yes ❑No current on en ear?? ❑Yes El 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
recorders office(induding 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
20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
I 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.
Signature(owners MI name) Date(rgorhth ,day,3 year)
Ful re5igermla0�ss n ben and sweet city;Pare.and ZJ�code) 4 1 b 7 b if I
Person authorized
by duly executed Power of Attorney or 6-1.1-112,2-0.77 Date(month,day,year)
Address of authorized person (number and street oily,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.