HomeMy WebLinkAboutMortgage_Hill (19) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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r FOR DEDUCTION FROM ASSESSED VALUATION ,
""r* ` State Form 43709(R13/10-15) cS 1M {1
y _ a' Prescribed by Department of Local Government Finance ��
INSTRUCTIONS: File Mark
To be filed in person or by mail.
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.
Ap icant(owner or contra b er-see restr+cti spn reverse side)
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Taxing7
�D � 2�Key number
0 legal� y9--n 12� --000 . 2 \9-p 0 la- R !rd number
Page� nC It
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the app' nt the sole•
CO
assessment(late,current year asseksment date,current year date of application legal or a itable owner?
0 Yes 0 No
If no,what is his/her exact share of interest? If owned with or one slther than spouse,indicate with whom
If name on record is differentthan that of applicant,indicate below: . e property in question:Annually Assessed
-- 6t Real:Property ❑ Annually Assessed
Mobile Home(lC tt.1 7)
Name of mortgagee or contract sell _ r Ej i
'
Drawer
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Address of mortgagee or contract seller(nu er and stye '''
1� DEC 0 9 2019
Name of assignee or other owner or holder of mortgage C I (1 1'tT O
Address of assignee(number and street,city,state,and .•..•,• SON 4 /
�% �;
COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? naa ,..,..action been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 0 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 approv in e a ount of
20 0 , , 20 20 20 ' 20• 20
Signature of Coo ud (�t C unk �� Date(murk day,year)
w \ Z — 6
1/We certify under the penalty of perjury that the above and foregoing infom is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
)cti
ignatu (owner's full name) Date(month,day,year)
II r " en ddr p li4 ,0(42119
gnt(numb d Six " , te,and ZIP de) 6 -.t 9 ,
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Person authorized by duly executed Power of Attpmey 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 un to two and a half years and a fine not to exceed S 10.000.