HomeMy WebLinkAboutMortgage_Velthouse STATEMENTFOR OFDEDUCTION MORTGAGEFROMASSESS OR CONTRACTEDVALUATION
INDEBTEDNESS County Township Year
State Form 43709(R13/10-15)
Prescrthed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Date& 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. ❑ County Recorder
2) Mobile I Manufactured Homes not assessed as Real Pmpe . t file with the County Auditor of the county
where the property is located during the twelve(12)months before 31 of each year the deduction is sought
See reverse side for additional instructions and qu ' ns.
•..,.-nt •-"te or ccoo�ntraactbu)eer/sue( /�rsee side)
T � ! •/dv�i � Record number
/Q/-063• Jc'se-001? 2_01(1 PaVG
•ssnswd value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicante the sole
assessment date,current year assessment date,current year date of application ^�,",� legal or equitable owner?�OJ(O 06JV ❑ Yes ❑ No
If no,what is his/her exact sham of interest? If owned with someone other than spv.co,indicate with whom
tf name on record is ddferent than that of ape/cant,indicate below. Is th property in question:Annually Assessed
Real Property ❑ Annually Assessed
• TT Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /7�co 1 r y B AA��
Address of mortgagee or contract seller(}number and sheet,city:ststaatteand ZIP code) ,t JfpV
Name of assignee or other owner or holder of mortgage MQR I 1 pO,n
Address of assignee(number and street,city,state,and ZIP code) CfgSON COO ��
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction._•" uw�e.�-s/fed If yes,state amount of deduction
in Indiana? ❑Yes No❑ cainennt year??for ❑Yes L7Ro
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 line 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 coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
/ ftir$Wre(awn ) Date(month,day,year)
!yam` ,V�,(`r,V�1t��I/q�lslu'��y/y��'� / ,y� �jy ///�� (� 7�
r�' un '`/ `- r't(n6 street dA:uo ' atafl.'/ ..///�/1.6-7` „ uF�• / 6 ?V
Person authorized by duly execute er of Attorney or by IC 6-1�.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.