HomeMy WebLinkAboutMortgage_Royalty -0► STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1 FOR DEDUCTION FROM ASSESSED VALUATION
.e'`* ,` State Form 43709(R13/10-15)
`�' i. 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 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 0 County Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 County Recorder
2) Mobile/Manufactured Homes not asse as Real Property:Must file with the County Auditor of the county
where the •':1%'- is locate during th lye(12)months before March 31 of each year the deduction is sought
See reverse side for ad. "o'- instructions d qua.cati ns.
Applicant eror con 1,-ct buyer-see trictio so ve side)
=i •Di 'at 7llal cri o GG��v. A Recrd number Page numb r
'''/ _o - a q 5304 .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage i Contract indebtednes unp 'd as of Is the applicant the sole
assessment date,current year assessment date,current year date of application.5� Bs- legal or equitable owner?
of El Yes El 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 th operty"• , estion:Annually Assessed
al P•L•- 1,1 • nuallyAssessed
, =bile Home(IC 6-1.1 7)
Name of mortga or contract seller ^J,^U . //^(('
t//-- V /_ � z 31e- _
Address of mortgagee or contract seller(number an street city,state,and ZiP code) �`to
�s / c, e3�V '141:may -,,
Name of assignee or other owner or holder of mortgage s I' `W
,L
04/ • n7
CO', jrAddress of assignee(number and street,city,state,and ZiP code) s.11, "j...'
ke
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,A stagfareunt of deduction
other county on property for
in Indiana? El Yes ❑No current year? ❑Yes 0 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
Signature of C ditor. C f - Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true an•`►.r , -i•i.-1 'ii pplican a resident of Indiana and
owne contract buyer of the aforementioned property on date application is filed. ',.k
Signs (owner's name) Date( onth,day,year)
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Full resident address applicant(number and 11--t,city,state,and ZIP code)
.%1•. 70 6. Pr^frice i7. 4-)`nr_eJvyi, TYU 1-17L717
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 foroeriury can include imprisonment Ile to two and a half years and a fine not to exceed. 10.000_