HomeMy WebLinkAboutMortgage_Hope " STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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. FOR DEDUCTION FROM ASSESSED VALUATION t• �l
•. . r� State Form 43709(R13/10-15) J 9 S On .W I V n � l
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S-„<rLhe Presorted by Department of Local Government Finance J
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Properly.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 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.
Apprinnt owner contact buyer-see restrictions on reverse side)
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Taxing W` ,,N . ZOD �g O l �- R � tk al
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebted0�ssss unpaid as of I Is the applicant the sole
assessment date,current year assessment date,current year date of applicationW I legal owner?
l‘<2 ` Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,inchoate with whom
It name on record is different than that of applicant,indicate below. Is property in Question:Annually Assessed
Real Property ❑ Annually Assessed
•���� _ / (l� '\ rL FILED
�ry�-p�jJ Mobie Home(IC 6-1.1-7)
Name�LM" 'V ( ' I I �7M C..inc� - 1 11LE:'/
Address of mortgagee or contract seller(number and street city,state,and ZIP code) '
Name of assignee or other owner or holder of mortgage AUG 7 - 2019
Address of assignee(number and street city,state,and ZIP code)•
t,�gGr��aumicciC
1 (��i1 � tl� (1
Does applicant own property in any If yes,what county? What Taxing District? HasV11511206Lb3n3€endrreequesteS l IPyes,state amount or deduction
imnIndiaana? ❑Yes ❑No current on fir?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
recorders 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
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20 20 20 • 20 • 20' 20
Signature of County Ave County Date( ,der
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I/We certify under the ally of perjury above and foregoing information is true and correct and that the applicant is dent of Indiana and
owner/contract buyer of the aforementioned property on date application is fled.
Vu�l` �lli Data( gyrla1
Person authorized by duty executed Power offAttomey or by IC 8-1.1-12-0.7 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 S10,000.