HomeMy WebLinkAboutMortgage_BeBord tJ q STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
, , % �'. FOR DEDUCTION FROM ASSESSED VALUATION
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':_a.;ter State Form 43709(R13/10-15)
g° -f ? Prescribed by Department of Local Government Finance
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File Mark
INSTRUCTIONS:
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 properly 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 loos during the twelve(12)months before March 31 of each year the deduction is sought
See reverse s' for additional instructions an qualifications. ��ff
Appli nt per r cog.`wt buyer-seepre�stricUo s cm reverse side)
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Taxin is ct Key ber/Leg ascription Record number Page number
oi6-/7 la/- �� �6 :&a Oa/ 2�0lq 4009
Asses valus°real propert Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
asse mentd,- current year assessment date,current year date of application legal or equitable owner?
(7p?o40D ❑ Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessed
Reeroperty ❑ AnnuallyAssessed
,,��ry Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller , / aCf
fiem 014e 4,, r
Address of mortgagee or contract seller(number and street city,state,and ZIP code) O`/+ p
Name of assignee or other owner or holder of mortgage a 2049
Address of assignee(number and street city,state,and ZIP code) C'/Bt30N
cCU/vTY/11�
Does applicant own property in any If yes,what county? Mat Taxing District? Has this deduction been requested If yes,steteidt otof deduction
other countyv'�ri<
in Indiana? ❑Yes ❑No onrrrett propertye for ❑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 Auditor ‘ County Date(month,day,year)
1,U
I/We certify under the penalty of perjury th t the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the of rementioned property on date application is filed.
Signatu et' full am Date(month,day,year)
Full t ress ap Ii nt(number d t, et, ,state,and ZI de) J)
Person authorized bydulyexecuted Power of AttorneyorIC 8-1.1-12- Date(month,day, ea
byY ►)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for cerium can include imprisonment uo to two and a half years and a fine not to exceed 510.000.