HomeMy WebLinkAboutMortgage_Parke (4) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
; S' FOR DEDUCTION FROM ASSESSED VALUATION I f(1I n�1_
'- °"\ A":.' State Form 43709(R13110-15) �� y,,in 1.�-'\ Zit g
S I Prescrbed by Department of Local Government Finance V�/�J • , l l
v File Mark
INSTRUCTIONS:
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 County Auditor or County Recorder of the county where the property is /krCounty Auditor
located on or before January 5 of the immediately succeeding calendar year. d 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 hvehe(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
ApO'dit(owner fray -see reverse side)
side)
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Assessed wade df real property as of Mortgage/Co indebtedness unpaid as of Mortgage/Contract indebtedness need as of Is the apgi. nt the sole
assessment date,current year assessment date,anent year date f\T t' ^ 0 legal or O u"dase o
If rho,what is his/her exact share of interest? If owned with someone other an sp' i.indicate with whom
If name on record is different than that of applicant,indicate below \Is the ptupoly in question:Annually Assessed
Nal Real Property 0 Annually Assessed
A Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller /_
Drawer NO tor. .. • FILED .
Address of mortgagee or contract seller(n
Card NO. q/ 72..
Name of assignee or other owner or holdeDEC 1 3 2018
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Address of assignee(number and street,1 ^/'j2
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Does applicant own property in any If yes,what county? What Taxing District? Has this dedu�rh p� 1/uestffiL to t of deduction
other county on property for ur � t,vuA . ,W"r.UU��i .
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the county
recorder's office(including any home equity rune 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:
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20 20 20 20 20 ' 20' 20
Signature of County Auditor County Date(month,day,year)
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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 1 contract buyer of the aforementioned property on date application is filed.
Sign? a(owner's full name ? Date(worlds,day,year)
rrr.mDb//1 12- 1y\ Y •
F dress of app' t(n and sbeet�city,state,and ZIP code)
I P if-1\4c
Person authorized by duly executed Power of Attorney or by IC 6-7.1-12-0.7 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. •