HomeMy WebLinkAboutMortgage_Bryant (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.;r, =,i.,a. FOR DEDUCTION FROM ASSESSED VALUATION I t
=_ oolt,r` State Form 43709(R13!1015) O �� I 101 CI
S ''' 4' Prescribed by Department of Local Government Finance
`.,
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.
Appii ntc (owneror co tract buye -searictionso rev ide)
ID
CAIII
TaxrDigtrict jum.it egad o Record nu r Page number
Assessed value of real property as of Mortgage/Contract hat ness unpaid as of Mortg ge I Contract indebtedness unpaid as of Is the applicant the sole '
assessment date,current year assessment date,current year d to f ap lira' legal ore itable owner?
Yes ElNo
If no,what is his/her exact share of interest? If owned wi someone other than spo - irate with whom
If name on record is different than that of applicant,indicate below 1, property in qu Von:Annually Assessed
pedy nually Assessed
cla.I
Na f mortgagee or contract sell(
Z11, bile Home(IC 6-1.1-7)
Address o rtgagee or contract se
c1�0 L Cr FIL AI"
• ....
Name of assignee or other owner or i q-55a ci y
I
Address of assignee(number and st REG_OpS DEC 2 2019
a5' LAO
—
Does applicant own property in any ,.rw>....a.,.,..,...,. _ _ las thi deduction b ,state unt of deduction
other county on pro for
in Indiana? ❑Yes ❑No I I cur n y ro I a EN CattibT AUDITO
A person is not entitled to this deduction unless the person has a balance on the person's mortgag r contract indebtedness that is corded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's o i that is the basis for the ded ction.
COUNTY AUDITOR
Deduction approved in the amount of:
•
20 20 20 20 20 ' 20' 20
Signature of County Au V.! County Date(month,day,year)
mA C34
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!contract buyer of the aforementioned property on date application is filed.
Si rl,r're(o isful n e) Date(month,day,year)
Y\( ; ,ar.� er 26—\q
i� �
Full -��en Tess ap scant( an street city,state,and IP d
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
1226-1°l -
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.