HomeMy WebLinkAboutMortgage_McKinney (4) 4„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'` FOR DEDUCTION FROM ASSESSED VALUATION
n=• ! ' State Fonn 43709(R13/10-15)
"--n% Prescrbed by Department of Local Government Finance TM I.L.JJJLLL File Mark
INSTRUCTIONS: ��� •
Tb be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property:Must be completed and dated in the calendar year is sought
Must be filed or postmarked with the County Auditor or County Rr136rBerof7he county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Mushfile ryifh. v rtor of the county El County Recorder
where the property is located during the twelve(12)months before dion is sought
See reverse side for additional instructions and qualifications. ell INN
Applicant(owner or tract buyer-see restrictions on reverse side) GIg50N
Pan if) i co/3i,r'In/ [' /Y)n_r�nnel
TaxingDi rKey number/legal desaipiion Record number Page number
)4Zi IYICf"1�'V I Z& -0l, -/'- oo-cco-qs� - ol-7 zo) y- oo16
Assessed valve of rea\ rnroperty as of Mortgage I Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,ark n�}nf+ntt year assessment date,current year date of application legal or equitable owner?
OW t es 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
d name on record is efferent t than that of applicant,indicate below. Is the property in question:Annually Assessed
.1-7)
Name of rtf1^n.'nyg'ah/g`ee or contract seller5-0 i�, - 00 / �
Address rrT mortgagTorcontact Gt seller(number and street city,state,and ZIP code) p'
•
Name of assignee or other owner or holder of nunpage
-
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property 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 No current year?ElEl ❑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 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
SVia of County Auditor Cow • Date(month,day,ye
I/We certify under the penalty of perjury that the aq-ive and foregoing information is true and correct and that the applican is a res' ent of Indiana and
owner/contract b r of the aforementioned prop on date application is filed.
XSign re owes name)) Date� /ay,ye
(number
9
u9 resident a tlress of applicant(number and street city state,�and ZIP code)
Co/ S'do e- 4/62, Al f—/ ANCrsCn 'ry `f76 �/
Person authorized by duly executed Power of Attorney or by IC&t.t-f 2-D.7 Date(month,day,year)
Address of audnnired 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.