HomeMy WebLinkAboutMortgage_Hornback rCSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
ounty Township Year
' _; FOR DEDUCTION FROM ASSESSED VALUATION
_.% l s State Form 43709(R13/10-15)
°,---,_,-/ Presented by Department of Local Government Finance �� �� � ��t
Li File Mark
INSTRUCTIONS:
To be filed in person or by malt Form filed with:
Filing Oates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought t -
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 1 [] County Auditor
located on or before January 5 of the immediately succeeding calendar year. f
LJ
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions andyqualifications. I I C�.,YI� /I�1/ r� 1Y r�1 �"�nLn
Applicant(owner
-.occontract buyer-�TS on reverse side)
0``eh t' s IVe�� r rKrr��q 1 `^'ofCCICAA L tip""- ry`•l� .
Taxing Ke.y number/legal
V `l.�V _ oLV 1 Zdescription
o l 1401 - 00I .�l M — 0 g 20`�\J Record number Page0 1 r
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment dale,ourte:nyear assessment date,parent year date offca a�pplication 0-1 legal or equitable owner?
�.p R ,0 O - Q Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom / \
1
m name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property 0 Annually Assessed
' / \ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller V
I .
Address � 1o''n . .
Address of mortgagee or contact seller(number and amyl,city,state,and ZIP code) ��
Name of assignee or other owner or holder of mortgage "L
Address of assignee(number and sheet,city,state,and ZIP code) 30 e,l 3 .017
Does
other applicant
property
own in any If yes,what county? What Taxing District? Hass dropeeduction been requested If a amount of deduction
in Indiana? ❑Yes ❑No current year?for ❑Y 1-{oR
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or a puD
s5 that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorders offi 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 enmity Date(month,day,yew)
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.
XSignature(owners full name) Date(month,day,year)
C2z -7w- \- 3. 19 .
Fun resident address of applicant(number and street,city,state,and ZIP code)
Z\\ F.- Vitn\ C • C\-ton , jn.
Person authorized by duly executed Power of Attbrey 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. .