HomeMy WebLinkAboutMortgage_Walker (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
lat FOR DEDUCTION FROM ASSESSED VALUATION
�' State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form vied with:
Filing Dater 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought El County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the immediately succeeding calendar year. D County Recorder
2) Mobile/Manufactured Homes not astassed as Real Property:Must file with the County Auditor of the county
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 and qualifications.
Applicant(owner or conbat buyer-see restrictions on reverse side)
.Soc,0fa; cz\-- 0
Taxing District Key number/legal descrf Record number Page number
a -to\- 3a �1y
- 100- Ooa- R-Oay 2olq e4-5r
Assessed value of real property as of Mortgage/Cou➢rot indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment data,anrem year assessment dale,current year date of application °Q. legal or equ" a owner?
37 I p00 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than cporicci,indicate with whom
If name on record is different than that of applicant,indicate below: Ist�,t,he��pro:perty in question:Annually Accessed
ly-fceal Property 0 Annually Assessed
• • Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller /r
AA Cr ( it-la- (e-cLJ�.� (Ix C
Address of mortgagee or contract seller(nu r and obeet city,state,and ZIP code)
.0
Name of assignee or other owner or holder of mortgage p c�
V
Address of assignee(number and atreet,city,state and LP code) o p�U\�
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested-, If jf 7! ryppyctt M deduction ' '
other county on property for �1�
in Indiana? Yes No i current year?❑ El Yes I1::l
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract inde PC.rr^: that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the comity recorder's office)that is :.?-..s for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
•
20 20 20 20 20 ' 20' 20
Signature of County Auditor County Date(month,day,year)
•
I/1Ne 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 aforementioned DDDccc•••000perty on date application is filed.
Sig L2E1
hr➢jame) 'I/ /�ar+�Z/P e� J n Date(month,day,year)
9 9� of 1(ns yribe/ 1/7 / /-7als{ di- V/1a.- j ..
3 nd by ury ex etl Powe1--)• tAtto r1 or by tIC 1.1-1 7 Date(month,day.year)
di_
Address of aui'vrired 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. •