HomeMy WebLinkAboutMortgage_Thome -9 . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION
':` State Form 43709(R13/70.75) Q
S / Prescribed by Department of Local Government Finance ""'•'
lJ 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 County Auditor
located on or before January 5 of the immediately succeeding calendar year. /�
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
whem 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 qualifications.
Anil err' yipra wn6ajr buye4-restrictions on reverse side Om c
11(/It�l Irk �ItL v `1`)` •
T g Dt Key nu /legal description nu a num
2.-06-4o3 -CC& 2S —o 23 1 ' 1g
Aesncced value of real prowla as of lse re
Mortgage I Contract indebtedness unpaid as of Mortgage I tract indebtedness unpaid IV Is the applicant the sole • •
assessment date,cumin year assesment date,current year date o(apot r��� Y' legal or itable owner?
- MO Yes 0 No
If no,what is his I her exact share of interest? other than sprfuse,indicate with whom
If name on record is different Chan that of apptra - r a�l� property an question:Annually Aecncsed
Drawer \O r YC�1 Reaf Property 0 Annually Assessed
/�'" �'— Mobile Home(IC 6-1.1-7)
s Name of mortgagee or contra seller �/C//
Card NO. -
VC)
Address of mortgagee or contract seller(numbe
r.
Name of assignee or other owner or holder of mortgage V \ •
1.1 � \ ' ��Y' 1tcA
Address of assignee(number and street,city,state,and ZIP code) /;�`,`,\„y,�r`• v �� 1•
0 1or O�,�pEL
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes • r TIN• — •OB i ucbon
other for n J
in tea? ❑Yes ❑No currentpear? ❑Yes 0 No I ‘GO
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedrh @g8 at is recorded in the county
recorder's office(including any home equity fine of credit that is recorded in the county recorder's office)that is the basis Wine dedur on.
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 I co ct buyer of the aforementioned prçelication is bled.Signature( s Date;month,18year)
Fu( _pht app :aneal mberard .�� '�11eet,city,1 a) l %) l • 1`-' _
Person authorized by duty executed f Attorney or fly IC 6-1.1-1 2-0.71 Date(month,day,year)
Address of authorized parson (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000. .