HomeMy WebLinkAboutMortgage_Cummings 01.•*e4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS FnILI Year
FOR DEDUCTION FROM ASSESSED VALUATION �
ie'.i..,1' State Form 43709(R13/10-15)
5 +•
.eie Prescribed by Department of Local Government Finance OCT 1 2019
File Mark
INSTRUCTIONS:
To be filed in person or by mail. F r 'h:
•
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 pro n ouny Auditor
located on or before January 5 of the immediately succeeding calendar year. GIBS N C O U NTT IT_t ry
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
jaunty ecorder
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 buy r-seprestrictions on reverse side)
Taxing Dj , ! Key nu r/le al descripti of Record number Page number
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 ssessment date,current year dale of ap Iica'/n/ J Y^ legal or equit Ie ownefT
/ 0 0 G Yes ❑ 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 t t of a plicant,indicate below: Is the property in question:Annually Assessed
L .— I-.1'''
^L° ^I O -�/f7 Q9 2 �al Property ❑ Annually Assessed
v v U l Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .
j' 27,_- W 4/1'0//1-� Z e-Address of mortgag or conked seller(number and stree'tt.armstate,and ZIP ode)
9/8 / y C2Sc /C/) # ° °LIifr//r✓/ C `' y VGZ4 f
Name of assignee or other wner or holder of mortgage /
Address of assignee(number and street,city,state,and ZIP code)
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 El No current year? ❑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
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 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 ontract buyer of the aforementioned property on date application is filed.
Signatur- (.wner's full n- e) Date(month,d y,year
Ful ent address of pplica n and street, y,stgte,and ZIP code)
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)
T o ncnarria¢fir nor1,,n,ran inrh,rla imnrisnnment un to two and a half veers and a fine not to exceed S10.000.