HomeMy WebLinkAboutMortgage_Fischer �',-- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES
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FOR DEDUCTION FROM ASSESSED VALUATION '
State Form 43709(R13/10-15)
' , Prescribed by Department of Local Government Finance
OCT 10 2q.l
e Mark
INSTRUCTIONS:
To be filed in person or by mail. Fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is soug
Must be filed or postmarked with the County Auditor or County Recorder of the county where th ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. N C OUNTY AP gounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyRatl�f 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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Taxing District Key number/legal description Re rd number Pag number
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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 legal or equitable owner?
1 SD) OCC. 0-0 Lam}-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 that of applicant,indicate below: Is the property in question:Annually Assessed
[a"Real Property ❑ 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)
Name of assignee or other owner 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 iNo 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/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.
Sign lure(owner's fultname\� C r ) `-— Dati(Lnanth,/mar)
ull resident address ofapplicant(number and street,crfy,staatle,and ZIP code) U17
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Person authorized by duly executed Power of Attorrfey 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)
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