HomeMy WebLinkAboutMortgage_Dyer } a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tr' FOR DEDUCTION FROM ASSESSED VALUATION
-. Stale Form 43709(R13I 10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: - File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly 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 ❑ County Auditor
located on or be!cm January 5 of the immediately succeeding calendar year. 0 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 in s and quabfa.etiuns.
Apcacant( or contract re on reverse side)n
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T . �zt, f they description / Record nu Page number
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Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year ssesvrent data,current year date of applic2 /r legal or equitable owner?
�/ ado Yes ❑ No
0 no,what is his I her exact sham of interest? If owned with someone other than sponw,indicate with whom
If name on record is(Efferent than that of applicant indicate below Is property in• Annually Assessed
Real Phuperty !..Atck,uallyAssessed
i (IC 61.1-7)
Name of mortgagee or contract seller CL
7 1 Para -4&.,)
Address of mortgagee or contract seller number anndbbcut,ay,state,and VP code) NO p
�/`� ��// w1.9
7' 1` 7.('� <U
Name of assignee or other owner or holder of r r:•- G
�' ,-- •, S� ate_9 GM a
Address of assignee(number and street city,state, - '0 P code) `-O(/
Vita
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amounfdf$rction
other county on property for ,'VVR
in Indiana? ❑Yes ONO current year? ❑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
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 at
20 20_ 20 20 20 20 20
Signature of County Author County Date(month,day,year)
I/We certify under the penalty of perjury that e above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I ract buyer of the mentio property on date application is filed. g
Signature ) bate(month,day,year)
NOP&�,
Full . n dress tut and street, ,and LP code
/ re g izLLreeadezi ‘04f. g��V9
P n authorized by duly executed of Attorney or by IC 6-1.1-12-0.7 Dare(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 S10,000.