HomeMy WebLinkAboutMortgage_Parker (3) ;, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�� ¢ FOR DEDUCTION FROM ASSESSED VALUATION
-7 State Form 43709(R13 l 10-15)
4°��e ," Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by maiL Form fiied 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 instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
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T g District Key number/legal description R rd nu r Page number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage i Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
* i L{y no0 °'O' [�Sres El No
If no,what is his/her exact share of interest? If owned with someone ogler than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the roperty in question:Annually Assessed
[ keai Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(number and street city,state,and ZIP code) ' ,:it
Name of assignee or other owner or holder of mortgage OCt
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Address of assignee(number and street city,state,and ZiP code) '
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Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested if•> $t9te i~ount of deduction
other county on rope for 0 in Indiana? ❑Yes 12 No currpent year? ❑Yes ❑No U pR
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 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
Si3e re of County Auditor i County Date([month,day,year)
1J1U—SQ� 10 — \ -1� .
I/We certify under the penalty of perjury at and foregoing information is true and correct and that the applicant is a resident of Indiana and
er/contract buyer of the aforementioned property on date application is filed.
Sig a i;IMp . I a t� ,Cl� De(month,day,yg r)j
Full resident add of a p113tct tanIPcode)am n. ��- t '�1\-A+mac ` k—i n-7D.
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 veers and a fine not to exceed$10.000.