HomeMy WebLinkAboutMortgage_Cates (2) .�, '►.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-"a; FOR DEDUCTION FROM ASSESSED VALUATION �q
17.-, � a
'- ., � State Form 43709(R13/10-15)
`eau''' d Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. F 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 properly 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)
Ser,cN't, c— L. C_ e Is) d- \ t1 k Qom 1)-:l n
Taxing District Key Dpmber/legal description Record number Page number
l�C.s�►r �/ .� >- O s� ' O S 000. (4�- , -017 ZOl 1 485V
Assessed value of real prohty as of Mortgage I 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 w� 0 Yes El
If no,what is his I her exact share of interest? If owned with somebne other thlan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the 12.(pperty in questio ':,,nually Assessed
eal Proper. .!`r' T ly Assessed
r •,ire Home(IC 6-1.1-7)
Name of mortgagee or contract seller .0-1'1 �
N 1 C � r$
& n
Address of mo gee or contract seller(number n street. ' ,state,an��d ZIP code) I 0 •
\AQ
Name of assignee or other owner or holder of mortgage j
►'�gPVO\-c OR
Address of assignee(number and street city,state,and ZIP code) , t VN�`(
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been reque If
yes,state amount of deduction
other county ,—, on property for �
in Indiana? El Yes LH'No current year? ` vr"❑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
Si ture of County Auditor C9unty Date onth,day,year)
I I We certify under the penalty of perjury that th abov:6. foregoing information is true and correct and that the applicant is a resident of Indiana bred
owner/contract buyer of the aforementioned property on date application is filed.
Si nature(owner's full name) �J fin✓ f Date(month,day,year)
1 r ent address tignt(nuhpand et, . ,state,'and ZIP kc
Person authorized by duly executed Power 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 oeriury can include imprisonment uo to two and a half years and a fine not to exceed S10.000.