HomeMy WebLinkAboutMortgage_Huck �.�., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
dl Win; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)4! ) Prescribed by Department of Local Government Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly.-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 instruction and qualifications.
Appli.. ((of,r contract•uyer-see 4-•�•ns on reverse side)
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T-.;; '-istri Key viper/legal descripti Record number Page number
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Assessed value of real pro .!of Mortgage/ ontract indebtedness unpaid as of Mortgage/Contract i debtedness unpaid as of Is the applicant the sole
ac�mementdate,current year assessment date,current year date of application legal or equitable owner?
// CrO ❑ 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 property in question:Annually Assessed
Real Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgag or contract seller C, '6����
Address of mortgagee or contract seile (n b r and scree ity,state,and ZIP code)
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Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and. •co,:) i '" TRACT 'Y (/ 4 2 ?O
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Does applicant own property in any If yes,what county? What Taxing District? Has this deduction bee s, a amount of deduction
other county on property for r��I/T),
in Indiana? ❑Yes No current year? ❑El E
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness titgiLlogorded 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 dedtictiiikp
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 1 contract buyer of the aforementioned property on date application is filed.
Signature r' !I na Date(month,day,year)
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x Full r rent address of pi nt(numb and street,city,state,and ZIP code)
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Person authorized by duly executed Power of Attorney or y 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.