HomeMy WebLinkAboutMortgage_Whitehead (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ] /� Q
l' State Form 43709(R13/10.15) r iM c,a/► ( q„��� 2Ol 1
Presorted by Department of Local Government Finance J �JJv I \N t '
INSTRUCTIONS: • File Mark
To be filed in person or by mail. F led with:
Fifing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked 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. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly 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.
Applicant(owner or contract OW&Tran19449719 on'evetse side)
Taxing
As of Is the " nt the sole
M�•mrent dare,axrrerR year assessment date,current year 0 v legal o e igable owner?
Yes 0 No
If no,what is his/her exact share of interest? If owned wi someone O spouse,indicate with whom
If name on record is different than that of applicant indicate belay. Is property in question:Annually Assessed
Property 0 AnnualiyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee��J seDer(number antl>beet city,state.and LP ilk .
Name of assignee or other owner or holder of mortgage MA? 3 0 2°19
Address of assignee(number and street city,state,and ZIP code) 16.9 /
Does applicant own property in any If yes,what county? what Taxing District? Hasei•, i! ( LresMdu, state amount of deduction
other county on
in Indiana? ❑Yes ❑No current year? ❑Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's min gage 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 recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of.
•
20 \( ?0 20_ 20 20 ' 20' 20
Signature of County Auditor IkaCounty • .Date(no t
tc
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is resid�t of Indiana and
owner/ ntract buyer of the afor ntion roperty on date application is filed.
gaiu nre s e Date(month,day,year)
s/r°/ac"
Full r en d of " (—(nu7mber tl sate,and ZIP code)
ors /1 j r,,> �1,0� ,�
Person authorized by duly execute Power of Attorney b mey or ylC 6-1.1-12-0.7 -� Date(month,day,yeah
Address of authorized person (number and street cif}:state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.