HomeMy WebLinkAboutMortgage_Deputy 4t,, 7► STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.� - ; FOR DEDUCTION FROM ASSESSED VALUATION
.A. -' State Form 43709(R13/10-15) 2D
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5 .,., -, Prescribed by Department of Local Government Finance ,
File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form 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. 0 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 revs si for additional instructions and qualifications.
Applicant wner r contract bu r-see re friction re erse s' )
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T ' g s Key n mber/ gal description Record number Page n mb r
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
accPssmentdate,current year assessment date,current year date of applicano legal or equitable owner?
// 5 31rj ❑ Yes ❑ No
If no,what is his!her exact share of interest? If owned with someone other that 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 mortgagee or contract seller � � rt
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Address of mortgagee or contract seller(number and street city,state,and ZIP code) pi
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Name of assignee or other owner or holder of mortgage t7 V2.®2019
Address of assignee(number and street,city,state,and ZIP code)
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Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been re u ate nt of deduction
other county on property for A T'
in Indiana? ❑Yes 0 No current year? LI Yes ElA
No Uri/ _
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is ref 1 ed in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's.offi'ce)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
ow
ner/contract b er of the aforemeritione ropey on date application is filed.
11 . Date(month,day,year)
h In n 6... 4 ' , -z,andZIPcode)
Person authorized by duly executed•Mr of Attorney or by iC 13-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for periury can include imprisonment Un to two and a half years and a fine not to exceed S10.000.