HomeMy WebLinkAboutMortgage_Manning a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
'-- =' :.- Stare Form 43709(R13/10-15)
Prescribed by Department of local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form sled 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 ❑ County Auditor
located on or before January 5 of the immediatey 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 g ))))))(fications.
Apt rant( tract buyer-see restrictions descrerseside) /Wall At
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T • %,mtnLu/� G /a-a .5uo - 0o a. goo - oat a Record number
�462?
Assessed value of real property as of IV��`; Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the safe
assessment data,current year assessmerd date,ament year date of application legal or equitable owner?
/aP�� a' ❑ Yes 0 No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on recad is different than that of applicant,indicate below: Is property in question:Annually Assessed
`Real Property ❑ Annually Assessed
n /l Mobile Home(IC 6-1.1-7)
Name a mortgagee o contract seller ( /�`�-'/"1i / EDAddress of mortgagee or contact seller(nu�and street,dy,state,and ) //
Name of assignee or other owner a holder of no , / 2,6ai I )aajcQ 87/3 N� 20/
Address of assignee(number and street,dy, l9 code) Gip.,
8
V Cot/ ••
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,stale 3rnbeafof deducta n
other county on property for '-'1 in Indiana? ❑Yes El No anent year? ❑Yes El No
o
A person is not entitled to this deduction unless the person has a balance on the persons 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 of:
20 20 20 20 20 20 20
Signature of County Auditor County • Date(month,day,year)
I 1 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 I co ct b r of the aforementioned property on date application is filed.
Signature s!u ram Date(month,1 day,year)
Fug Sd app nu �,• -s- dry,state,an code) I-/IV (�
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authorized by duly executed -f•Atom by IC 6-1.1-12-0.7 Date(uwhd4 day,year)
Address of authorized person (number and street city,state,and ZIP cede)
The penalties for perjury can include imprisonment up to two and a haff years and a fine not to exceed$10,000.