HomeMy WebLinkAboutMortgage_Hurlock CSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�4�;s FOR DEDUCTION FROM ASSESSED VALUATION
-•••j�^�ya;=" State Form 43709(R13 r 10-15)
5 =1 Presorted by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form tiled with:
Filing Dates 1) Real Properly 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. 0 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 twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Appticant owner or contract buyer- )
see on reverse side
Arna.f-Nda is r 1 o c_AL .
Taxing District nlber I legal description Rec t Pmee nun?0&tk&cAC " lu -18 aAC), 00I zoO- OO 1 . 26 Un .
Assessed value of real of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of s the applicant the sole
assessment date,current year assessment date,current year date of application legal orowner?
4a , O�� es ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
N name on record is di ferent than that of applicant indicate below: Is the y ' ' •n:Annually Assessed
'
LN"Reat •s)\ Ann Assessed
IutobleHo» 1.1-7)
Name of rtgagS contract seller
ee
Address of mortgagee Of contractnseller `(numbber and street rev Mato,and 71P.wort - —- �� rO\�
0Z0 i 9 - 00 89 pp�� e
Name of assignee or other owner or ,Y` •1 -(l7
Drawer NO 1P�o\
Address of assignee(number and a ON
O
Card NO. a
Does applicant own property in any its deduction been If yes,state amount of deduction
hia ? ❑Yes ❑No II3yeah ❑Yes No
A person is not entitled to this deduction unless the person has a balance on the person's mor gage or contract indebtedness that is recorded in the county
recorders office(including any home equity line of aedit 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 mentioned property on date application is filed.
Sig re(omw S am Date(month,day,year)
.F191 resident�adpress of a • t(n tuber and saeet city,ete,and LP code)
stg f o SI- atklai1 Jy N 4/76Koo
Person authorized by duty executed Power of Attorney or by IC 6' .1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed S10,000.