HomeMy WebLinkAboutMortgage_Davis (41) STATEMENT OF MORTGAGE OR CONTRACT INDE:' -1. ESS County Township Year
t �'}i" FOR DEDUCTION FROM ASSESSED VALUATION
p^�+i.- State Form 43709(R13/10-15) r`,
Presrnbed by Department of Local Government Finance .,r ta
INSTRUCTIONS: MAY 1 File Mark
To be filed in person or by mail. 20�o Form Sled with:
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which I.: deduction is s8ught
Must be filed or postmarked with the County Auditor or County Reorder• V,,county, ere the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding ca � ,. Tjnr—./ 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file• Loop.,rn6- r, of the county
where the properly is located during the twelve(12)months before March 31 of each...A eedde�duu is sought
See reverse side for additional instructions and qualifications. ��"I TOR
Applicant(ow or on(revverse side) n ,,' ,
en,
T_ D" � Key do. ! description � D T o- 0d.1- 20 1Record Vier
Assessed value of real pmpertytd Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year I{aasssessment date,current year date of appl' legal or S ^� equitable owner?
O VCC) ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is/Efeerent than that of applicant,indicate below. Is property in question:Annually Assessed
Real Property ❑ AnnualyAssessed
/
Name of mortgagee or contract seller '��+r�V`'`�' Mobile Horne(IC 61.1-7)
Address of mortgagee or contact seller(number 4.city,slate,and ZIP code)
Name of assignee or other owner or holder of mortgage
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? ❑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(induding any home equity line of credit that is recorded in the county recorders 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 Auditoc., �i% �fy County - Date(month,day,year)
I/We certify under the penalty of perjury that e 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 filed.
Signature(owner's Na name) Date(month,day,year)
'7V ..eitat.P,o. 6 ..---
Full resident address of applicant(number and sleet city,state,and ZIP code)
637 u1kco4gf: gram c4 _7-... ii7.4efS' .
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street clly,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. - "-