HomeMy WebLinkAboutMortgage_Weales STATEMENT OF MORTGAGE OR CONTRACT INDE tdt' SS County Township Year
i! 7 FOR DEDUCTION FROM ASSESSED VALUATION : 1
T State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: Mq y 2 File Mark
To be filed in person or by mail. 2019 Form led with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for wh ijn e deduction is sought
Must be filed or posbnarked with the County Auditor or County ;: P_: where the property is County Auditor
located on or before January 5 of the immediately succeeding cale n,0�./ ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with�61!.-r ditor of the county
where the properly is located during the twelve(12)months before March 31 of each -al(ryrdudion is sought
See reverse side for ttional instructions clions and qua
OR
App6can (ow con a -see restrictions o/?eves¢ side)
(L/% ,i aL", 0163-60/ 52/-007 Rapid bpc P %
Assessed va of real Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application Jrlegal or equitable owner?
/ / a22 ❑ Yes ❑ No
it no,what is his I her exact share of interest? If owned with someone other than spouse.indicate with whom
If name on record is different than that of applicant,indicate below: is th property in question:Annually Assessed
Real Property ElAnnuaMAssessed
��/ \\\ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
/a z,i.,/,„ (c-n_7.--d )
Address of mortgagee or contract seller(number and street dry,state, nd P code) a es
Name of assignee or other owns o er of �etgje �� l/ 2E //y7-6.7 2 iitg`ge
Address of assignee(number and ,Ty " ,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
ott in Indnddiiaanunty a? Dyes El No cn currrent�year?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 office)that is the basis for the deduction.
COUNTY Al
Deduction approved in the amount of. //J�I/�(�
20 20 20 20_ Drawer NO aV at 20
Sign' troy Auditor —7 — / ��j year)
!AA1 �t Card NO. ..................
I/We . under e penalty of perjury that the above and foregoing infomu......v —..___..___._ _ .. lent of Indiana and
own / rthact buyer f th rernentioned property on date application is filed. " -
5 s null norm � Date(wraith,day,yea,)
MI resident address " t(number and streeet,E- OnYdYty,,ssjtate,and ZIP Person authorized by duly3exea$ed Power of Attorney or bt IC 6-1 1 1`Y--0.7 CA-1t / �� (eCiDate(month,day,year)
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Address of autiNi iced person (number and sheet city,slate,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. .