HomeMy WebLinkAboutMortgage_Fougnies (2) 0-- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES , u��y s ship Year
41. FOR DEDUCTION FROM ASSESSED VALUATION I`
1 State Form 43709(R13/10-15)
S :To"- Prescribed by Department of Local Government Finance
INSTRUCTIONS: JAN 1 3 2020Fle Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly.-Must be completed and dated in the calendar year for which the deduction is ht Must be filed or postmarked with the County Auditor or County Recorder of the county whe h County Auditor
located on or before January 5 of the immediately succeeding calendar year. l U D I Tia County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CouA RN4 99iUgl 't/
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.
Applicant(o er or contract buye see restr'ctions on reverse side)
erte-
T ' District Key number/leg description Record number Page number
ai (o- K- 3 -- doo - oo I. o Y9-oa7 �020 0\E0
eased value of real property s of Mortgage 1 Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applican the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
a33 4-100 0 Yes El No
If no,what is his/her exact share of interest? If owned with someone other thait'spouse,indicate with whom
if name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Pgr2ea1 Property 0 AnnuallyAssessed
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street:city,state,and ZiP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction 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 approved in the amount of.
•
20 20 20 20 • 20 ' 20' 20
Signature f County s / County Date(month,day,year)
I/We certify under the penalty of perjury that the above a foregoing information is true and correct and that the applicant is a resident of Indiana and
owner 1 contract buyer of the aforementioned property on date application is filed.
VSignature(o s na e) /D/aatttee(month,day,year)
Full r i n ddress of app (n ber and s t,city,state,and ZIP co e) la/7�7�
1, (-1-- i 4)---) 11 76, 70
erson 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 perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000. . -