HomeMy WebLinkAboutMortgage_Allen (8) }} STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�` ' FOR DEDUCTION FROM ASSESSED VALUATION
�'- State Form 43709(R13/10-15)
Presorted by Department of Local Government Finance Pit 1
INSTRUCTIONS: • Ft
To be filed in person or by mail. '4 y Forth fi '� .
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought 1
Must be filed or postmarked with the County Auditor or County Recorder of the county where ke props • s +County Auditor
located on or before January 5 of the immediately succeeding calendar year. $ III County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor o .-,located •• ^
where the property is during the twehe(12)months before March 31 of each year the deduction is A ,•te'41jv,
See reverse side for additional instructions and qualifications. �. #•
. Applicant(.•- or contract buyer restrictions on reverse side) �Gbf R
Taran. +'�'ct //legal descri r0
el iri /( 3 � -��i3 ?off-L / _ �d� R7G; 7tal
A .l'.tile of real property as of Mw(gage/Contract indebtedness unpaid as of Mortgage 1 Contract indebtedness unpaid as of Is the applicant the sole
assx•ment date,current year assessment date,current year date of application legal or
//7 ,f equitable owner?
0do ❑ Yes ❑ No
t no,what is his/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 the property in question:Annually Assessed
Real Properly ❑ AnnuallyAssessed
• jam Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller , /) 67
Address of mortgagee or contract seller(number and//(street `ity Lstate,and ZIP code)
Name of assignee or other owner or holder of coo( 2, 1 //�� / 44741
a
d�9 C/ T/J/
Address of assignee(number and street city,state.a )
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
otter county on property for
in Indiana? ❑Yes El No current year? ❑Yes 0 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 1 20 • 20 ' 20' 20
Signature of %Auditor c `S;.J�i /"' County • Date(month,day,year)
IW_J rtt fy
We certify under the penalty of penury 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 filed.
.skSig (owners bin� w d name) `/','_�i�fe'— Date(m .th,day.year)
F esident addressLUapplicant(number and street city.state,and ZIP code)
h
/oS' .5. dues} ccT. Fo.< Sae.eh ra' V)6Y8•
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 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.