HomeMy WebLinkAboutMortgage_Thomas (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- � FOR DEDUCTION FROM ASSESSED VALUATION
1'` State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance FILED
INSTRUCTIONS: File Mark
To be filed in person or by mail. BAN 2 3 2 J n eted 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 0 County Auditor
boated on or before January 5 of the immediately succeeding calendar year. nty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CounyAuditor of th)J Cou
s ) CEi <1�
T g District Key number I legal description Record number m r
4 a gG - 65 — 30 - / 6/ - 663 - 30 ,1 _ 0 ,>, 7 C
A�sN value of real property es or Mortgage t Contract indebtedness unpaid as of Mortgage I Contract indebtedness nppaO 1 f Is the applicantMe sole
assessment data,arrant year assessment date,current year date of application legal or equitable owner?
? O3 . , $ O ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other n(an%pmmcr,indicate with whom
If name on record is dffererd than that of applicant,indicate below Is the property in question:Annually Assessed
❑ Real Property 0 AnnuatyAssessed
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contact seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and atreat,city,slate,and ZIP code)
Does applicant own properly in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 0 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 contract indebtedness that 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 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 I contract buyer of the a`o. remelt- ned property date application is filed.
Signature full ame) Date(month,day,year)
/7.23/20,45---"
Full ' a , t(n f and sheet, " ,state,and ZIP code),_
./ ,....1- 1/ /i" /Jriictt scar,r /iir Zia.1 lle0-z,.r �4 L/.767a
P n authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 r Date(month,day,year)
Address of authorized person (number and street city,slate,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.
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