HomeMy WebLinkAboutMortgage_Newton (7) : STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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Prescribed
DEDUCTION FROM ASSESSED VALUATION al�Q,/� �. 1
. ' State Form 43709(R13/10.15) (�/j�
�-- Prescribed by Department of Local Government Finance _I "`�����.•••
INSTRUCTIONS: File Mark
To be filed in person or by mail rm fled with:
Filing Dater 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orpostmadred 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. 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property 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.
Apptiard�uw%pr con 1 selglasu • on remise side)
```` \�` numberTalsing,. Key m
nber
(A). ysi.e.A . 0 t4 legal
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3C0-O DO. 03 —0 ► $ Record20 Part
ete24— .
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness gepaid as of Is the applicant the sole
assessment date,aurent year assessment date,current year date of sir:ahonn 0o 0 CY legal or equitable Yes ❑owner?
El
No
If no,what is his I her exact share of interest? If owned with ne//�"ott�1hl erihan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: property in question:Annually Assessed
Real Property ❑ AnnualyAssessed
• Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seller Q'j IJ�JI i?c,AfriLF
^`e„ IL
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Address of mortgagee orccontractseller(number and street,art:�,and LP code))
Name of assignee or other owner or holder of mortgage APR 2 5 1019
Address of assignee(number and street city,state,and ZIP code) �r�+r y t�
Does
apcoplicant own property in any If yes,what county? what Taxing District? Has �j requesccv IR21 state amount of deduction
otin Indiana? ❑Yes ❑No current year?rty for ❑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 olfnw)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 • 20 ' 20' 20
K .9„5,county...„;_„\c„..„—m) County Date
re t9
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!contract buyer of the aforementioned property on date application is(fled.
A/ Signatu (owner' full name) Date(month,day,yew) rQy
/`(\\I'` dressicf appp num a sCaetf aly,Stt,arrci i de) /1���
erson authorized by duly executed Power of Attorney' Vl or�ICt(•6--•11 11 11 222-1 771r_y\ D (month,day,yea
' 2, - Vet s •
Address of outhunted person (number and sheet 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 S10,000.