HomeMy WebLinkAboutMortgage_Lester ',* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
s FOR DEDUCTION FROM ASSESSED VALUATION ��1'/ 1�Fill" o Q
-=_ '^ State Form 43709(R13/10-15) w Z l
%-< -� Prescribed by Department of Local Government Finance I ; fl;
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INSTRUCTIONS: .
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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 n p r 1 32. 8
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property " County Auditor
located on or before January 5 of the immediately succeeding calendar yearD2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the ty _ 1" '� County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction N-u—
Seereversesideforaddilronal instructions and qualifications. GIBBON r.Oily-ry AllntTrlp
App
t owner or contract buyer-see restrictions on reverse side)
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Taxing District - Key number/legal description Record nu r Page nuez
217-/2'07-904i -a)z. 4199 —0 2. 23i 14R16.4
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 sop -
assessment date,ameid year assessment date,current year date offf aP l�iatti7on legal or equitable owner?
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If no,what is his I her exact share of interest? By �� If owned with someonejther than spouse,indicate with whom ) as ❑ NO
If name on record is different than that of apphrant,indicate below: ?property is question:Annually Assessed
Real Property 0 AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of no ee or contract seller
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Add of mort 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,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 d deduction
other county on property for
in Indiana? ❑Yes El 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
recorder's office(induding any home equity!me of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved hi 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 I contract buyer of the aforementioned property on date application is filed.
grata (amens fz4eameL Date(month,day,ye
a `''' '- aid lot Ate{ZI 12-
un resident ad ofa number�dstree; e.and ZIP code)
-10 I - SIN ram. Yi'Mci on . 1-}-p ie-1 O
Person authorized by duty 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.