HomeMy WebLinkAboutMortgage_Mizeur (3) .i STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i. - FOR DEDUCTION FROM ASSESSED VALUATION �l�
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- State Form 43709(R13 t 10-15) ,n/1
` ,,, e. Prescribed by Department of Local Government Finance s w 1 '
INSTRUCTIONS: File Mark
To be filed in person or by mail. Fo 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.
scant(owner or contract buyer-seep restrictions on reverse side)
Vr7 Ae/Ni . kn\y2Qe 1is7oa A
g �� , C.�T�� \ o � (�p �m�v aC)1 l number Record Ppge hum r
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortga.-/Co ct indebtedness uEt5 as of Is the pp4li.-nnt the sole
assessmentdate,current year assessment date,current year date•'a•plic r io� �� M legal.r/.•I r ble owner?
(( o, .I Yes 0 No
If no.what is his/her exact share of interest? If owned with so 'epne other*an spouse,indicate with whom,
If name on record is different than that of applicant,indicate below. property in question:Annual'. Assessed
perty 0 AnnuallyAssessed
c Mobile Home(IC 6-1.1-7)
Name of m agee or contract seller %�
Address of mo agee or contract seller(number and street city,state,and ZIP code) \I ®�(�
Name of assignee or other owner or holder of mortgage yo v
o • -- -4(PP.4;'....'-'
Address of assignee(number and street,city,state,and ZIP code) -OW PUp1'CO"
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 . 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 - ..mount of:
20 i 2 20 0 ' 20' 20
1
Signature of County A . t County ^• Dat ( anth,day,yea
I/We certify under i,- • -nalty of perju that th and foregoing information is tru and correct and that the applicant is a resident of Indiana and
/ er I contract buyer of the aforementione property on date application is fried_
S.• re o ers 1 nam Date(mon day,y1e
u:?dent address of applicant mber an. . et, e,and ZIP code) /' •
C s� I cAD Lep, - on- 1 66
Personauthorized by duly executed Power of Attomey'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$10.000.