HomeMy WebLinkAboutMortgage_Masters T STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
kit. �' FOR DEDUCTION FROM ASSESSED VALUATION V
�'^ State Fomn 43709(R13110-15) J Y
Prescribed by Department of Local Government Finance F
.r.e.ee E i
INSTRUCTIONS: (yam
7b be filed in person or by mail DEC 7 201T--medwin:
Filing Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orposbnadced with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. r/
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor tjt& �CouMy Recorder
where the property is located during the twelve(12)months before March 31 of each yeareilialitgatliOntssrnhrt AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-seer Owns on reverse sidle) Q �(
Taring District-Al/ Key member!legal desaip nA, R�ortl ri e er Page_I m lr .
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Assessed real property of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment current year assessment date,current year date of application legal or equitable owner?
/ 23 otoo ❑ Yes ❑ No
If no,what is his I her exact share of interest? if owned with someone other than sprgre,indite with whom
If name on record is efferent than that of applicant indicate below. Is the property in question:Annually Assessed
kiteal Property ❑ AnnuaflyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee a con Iler
Trcq
Address of mortgagee or contract seller(number and street city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dty,state,and ZIP Cede)
Does applicant own properly 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 current year? ❑Yes 0 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(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/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.
/
KSign.ature( fort name) f / Data(month,day,}rear)
Full resident address of applicant(number/and street city,state,and ZIP code) ,
9 SS 7 C<.) 575 S 1/4-7-4—' Y`766 5
Person authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7 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.