HomeMy WebLinkAboutMortgage_Moore ;!► STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ' County Township Year
/' ' - FOR DEDUCTION FROM ASSESSED VALUATION
,• • State Form 43709(R13/10-15) � � , 1 1(Abaci e r
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e -�n�e'= d Prescribed by Department of Local Government Finance
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. 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�DQ_ contract buyer-see restrictions on reverse side)
L.
T -n istriict Key nu`bed/le sal description Record number P e nu er
26
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Assessed value of real prpe(Ey as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the cant the sole
agsenment date,current year assessment date,current year date of application, n OD legal o unable owner?
6'O 'W • Yes ElNo
If no,what is his/her exact share of interest? If owned with sometrne ot?er than spouse,indicate with whom
if name on record is different than that of applicant,indicate below: I V-property in question:Annually Assessed
I.+ Real Property ❑ Annually Assessed
_ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sell F
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Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ()CI 1 - -2°19
Address of assignee(number and street city,state,and ZIP code) •
��(n1` NTY_A DITOR
Does applicant own property in any If yes,what county? What Taxing District? Has thi�jgB li Ilderl tbquested If yes,state amount of deduction
other coupp5tirty
in Indiana?y ❑Yes ❑No onrrent year?r ❑Yes 0 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 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)
AAVV1 1 l0 • l • 19
I 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/contra buyer of the aforementioned property on date application is filed.
Signaturl'wn iIna ) Date(month,day ar)
X F : iden a ress of ap li t(number nd street city,state,and ZIP code)
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•erson authorized by duty executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day, e�j
`to, 1. �
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.