HomeMy WebLinkAboutMortgage_Whitehead (10) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110.15)
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Prescribed by DepaMteM of Local Government Finance
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�INSTRUCTIONS: - N�-{
To be filed in person or by mail. Form bled 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 NOVAuditor
located on or before January 5 of the immediately succeeding calendar year. 0 County Recorder
2) Mobde/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county n,
where the property is located during the twelve(12)months before March 31 of each year the deduction is t "
See reverse side for additional instructions and qua .
1 r
Applicant(owner or n buyer te^strf_ ) �lir '^ - ^f;IR�r1 AI r�r�L� ::.AUDITOR
Taxing District N�,Y y / 11(�,(,(_.Q,Q-I/1 Record number Page number
( - 9— LIDO— COO- Sacry 8 tii q
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of O�tin legal or equ'dab!e owner?
Li ❑ Yes ❑ No
Utz
410(
I no,what is his 1 her exact share of interest? If owned with someone other Shan spouse,indicate with whom
If name on record is efferent than that of applicant,indicate below._ - --. I Is the property in question:Annually Assessed
n.oil Property 0 AnnuallyAssessed
' ��ll t/ a Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller :2 V( J / / 0 .
Address of mortgagee or contract seller(number and street city,sl Drawer NO
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? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No anent 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
recorders office(mduding 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/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. y\Jre $�
S.,�.. -(owrhers full name) 1` � 'te(month,( IdaJ a� U
..a. - /l JyJ
•:- address of a{pfipm(number and sheet dry,state,and ZIP code)
2 -T)L-1 c S. -ISO e -'hc1/46-.r•;,s Ca .ni‘' (-1-1c 9
•_-.h authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
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$10,000.