HomeMy WebLinkAboutMortgage_Priest } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION r�/
�' State Form 43709(R13/10-15) r. �� A (A � <
�- Prescribed by Department of Local Government Finance ..JV,V --11
INSTRUCTIONS: _ File Mark
To be filed in person or by mail. Form filed with:
Filing Oates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmadred with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediatery succeeding calendar year.
ile/Manufactured Homes not assessed as Real ProCounty Recorder
2) Mob 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.
Alain (own«ctcontrf�f ette restrictions on reverse side)
T 9 11i r^(�� Key number/ description Record number Page number
N . Dia - °LA—LC lnl -000369----C9,0 70R t621
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment data,current year date of ion 07 legal or itable owner?
— . Yes 0 No
If no.what is his I her exact share of interest? If owned with sorZne oth r than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. I property in question:Annually Assessed
Real Property ❑ MobileyAssessed
• Home(IC 6-1.1-7)
Name of mo ee or contra seller
29d �� P • FILE '!s Ire Mn,
Ad of mortgagee or co - -' -• -Y. .
Name of assignee or other owner or he 4 0 / / _ /6° /
JUN 2 5 2019
Address of assignee(number and stye Drawer NO `01^•
•
Does apWicant own property in any Ca I-CI i\rO• Hawk eset l®Ebtt- fM Di W state amount of deduction
other county on Property for
in Indiana? ❑Yes 0 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(including any home equity fine 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 20 20 20' 20
Signature of County AW `m1 Count\ Date( da
Q� V
I/We certify under penalty of perju at the above and foregoing infonnatit\ CSC?? gn s true and coned and that the applicant' a rest nt of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
�f Si� (owner e� C f Date(moray,,
fl\\run resident ad of a t(nut xM �� state,ti�P code) 1/� 1'
Xr(V7 C,�T (IJ 1/4.? t
L � o I u
Person authorized by duty executed Pother of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street cityy,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.