HomeMy WebLinkAboutMortgage_Matsel (2) �, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
or):: FOR DEDUCTION FROM ASSESSED VALUATION `
J, '' State Form 43709(R13I 10-15) �` � O\ `,�I ��G '
Prescrfed by Department of Local Government Finance 1'�.] v' F _
INSTRUCTIONS: _ File Mark
To be filed in person or by mail. Form filed with:
Filing 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.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county ounty Recorder
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.
AppErynt(` = or conaart - msaic8ons on reveres side) 1
I 1(Yll �,/1`
1 - V
Taxing D'��i Key num legal tlesrn � ---. Record number Rage nu tree
0\v` 9-6- 1 -ni Okst -COO ,G 3 - 02 - . zoo. ictG�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ tract indebtedness tin id as of Is the icant the sole
assessment date,current year assessment date,current year date of legal or q - We owner?
7,.r Yes ❑ No
If no,what is his/her exact share of interest? If owned with other tha O,indicate with whom
if name on record is afferent than that of applicant,indicate below- Is property in question:Annually Assessed
0 Property 0 AnnuaMAssessed
Mobile Nome(IC 6-1.1-7)
Name of mortgagee or contract seller I1 1 O�
1`
Address of mortgagee or contract seller(number and street city,state,a ZIP code) F IL 1
Name of assignee or other owner or holder of mortgage g j1 1JA'��0 6 2O,(1
Address of assignee(number and street,city,state,and ZIP code) J U Iv 7
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti�oon�pbbeeen N-iryakoWeT tfint of deduction
in Indiana? ❑Yes ❑No curr on property
nt yea n`1:3 YesN No
A person is note • is deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office( .r udi • ny home -••' line of. , that is recorded in the county recorder's office)that is the basis for the deduction.al
6:11.1N1„:\Y AUDITOR
Detluction approved• 'itot
•
20 20 20 20---1 20 ' 20' 20
Signature of County Auditor ( /of County^\ r Date(tt gee,
I,We certify under the penalty of perjury that the above and foregoing information is(1\btre and correct and a_sthat the applicant is rees' ent of Indiana and
owner I contract buyer of the aforementioned property on date application is filed. 1 )
Signature(owners fun name) / '�✓`/^r��y'f//�'1—iET Date( fh„dayrr(b9arVT
mi atl of t(num/ bee and street tlryt crate.and ZIP code) 111.11(l q 1 "11
dl\e �1 . lob
Person authorized by d executed owe Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street 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 S10,000. .