HomeMy WebLinkAboutMortgage_Mills (7) .14�J.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship Year
�` " :„ FOR DEDUCTION FROM ASSESSED VALUATION
State Fomr 43709(R13!10-15)
4° .`; - Prescribed by Department of Local Government Finance
Feu
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form fled 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. ❑ 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 instructio; and qualifications.
Applicant(own contract buyer-see •.i'ru ns on reve sidey,
i//.S, 4 `a-z
T-?A I i ct K- number/legal description Record number Page number
.. �- 02-0?-/ 3-00/. /acA-Qa F 2_0IQ 3°fil 9- •
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 date,current year date of application ) �j O legal or equitable owner?
pf 4a1• ❑ Yes El No
If no,what is his/her exact share of interest? If owned with someone other thar/spouse,indicate with whom
tf name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Real Property ❑ Annually Assessed
\ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller V
Address of mortgagee or contract seller(num r and street city,state,and code)
Name of assignee or other owner or holder of mortgage Lizir;itiagii -7,A
Address of assignee(number and street,city,state, d IP
/..'
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
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 persons 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 20 - 20 ' 20' 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury 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.
S' lure(ow -r's 11 �,�� Date(month,day,yew)
Ip/Full r ident add- -oJY .WOk)%
spell numbnd street zie,a d ode)
6/9 . d �� �.i &
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.