HomeMy WebLinkAboutMortgage_Peil (2) an•. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year-� '4 FOR DEDUCTION FROM ASSESSED VALUATION
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_ = State Form43709(R13!10-15) v� 1 yt l`�
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' - ',„„; 1 Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Fo led 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 rave side for additional ins ctions and qualifications.
Applicant never 1 ntract i - restrgns o reverieside; 1 5? ,
Taxi Di trict `m rV,1�
ey bar/le al descri lion Record number Page number
1-� vY'. 2t- b�5 — 03 2-- o0o 2,41\019 , 2013 Li Li 13
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortga e I Contract indebtedn�unpaid as of Is the a.pli nt the sole
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assessment date,current year assessment date,current year date o applin ^& r legato �,• itable owner?
l/JI 11Yes ❑ No
If no.what is his!her exact share of interest? If owned with omeOne oilier an spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I e property in question:Annually Assessed
Real Property 0 AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
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Name of mortgagee or contract seller P • �'(,��c_
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Address of mortgagee or contract seller(numbe heat city,state,an FIL ! 7 x
2)(
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Name of assignee or other owner or holder of mortgage Drawer NO..
Address of assignee(number and street,city,state,and ZIP code)
Card NO (may(,yC OCT 8 2019
. . U -4
Does applicant own property in any If yes,what county? Whi ted If y-4%i.; .
/ .== r,l��j:�/-.uction
other county I SON C
in Indiana? ❑ ❑Yes No I current yea�r .� 1. OUNTYAUDITOR
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 a • t of:
20 *.. 20 20 20 ' 20' 20
Signature of County Auditor (._..\ ' (T6D Coun Date(month,day,yea
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 th foremerttioned property on date application is filed.
ISignatu ers full na Date(month,day,year))
Full resident addressi nt(number a d street,city,state,and ZIP code)
kOR
Person authorized by duly executed Po6r 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 years and a fine not to exceed S10.000.