HomeMy WebLinkAboutMortgage_Fortune (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'' '
' FOR DEDUCTION FROM ASSESSED VALUATION 1� ,- ��
- State Form 43709 R13110-15) J \J v 1‘
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
lD be filed in person or by mail. Fo led 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 properly is County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
when the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and brr qualifications.
App t (pLVI rktr seersp0.9ntsoen t m. p` r
r
S� �b rterti9-300 -002 kqs----oag4M r 2\h' .
es Asssed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpa as of Is the applicant the sole
assessment date,current year assessment data,current year date (its ij 0 V^ legal or equi ble owner?
0 Yes 0 No
If no,what is his/her exact share of interest? If owned with ne n spykse,indicate with whom
If name on record is different than that of applicant,indicate belay. is the property in question,Annually Assessed
0 Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Na rtgagee ar contract mar �--� e .
�Ct —Ig FILE. i
Add mortgagee or cont t cat,act seller(number and street, state,and ZIP !1 code) l
Name of assignee or other owner or holder of mortgage
2019
Address of assignee(number and street,city,state,and ZIP a , r ; /Tn' r�
Dices applicant own property in any If yes,what county? V v l 1 FORT
U C c
Wta amount d deduc ion
in Indiana? ❑Yes ❑No FC
A person is not entitled to this deduction unless the pen tedness that is recorded in the county
h MIA rkr's office Ono/tiding any home equity line of aed. , ‘ ,5 ox 'sis for the deduction.
,
Deduction approved in the amount of
20 20 20_ dN/`1 7—�h29 20' 20
S � �3 lJ `2 day,9
I/We certify under the penalty of perjury that the ab applicant is a resident of Indiana and
owner I contract buyer of the aforementioned proper
'XSw-r�reZr# Tnand
day,y ' kef
Fullr - gnt , P )12- E \2GOs \- nkln .
Person authorized by duly executed Power of Attorney or by C 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city state,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .