HomeMy WebLinkAboutMortgage_Fox (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESc' .it
'S ship Year
.. ' FOR DEDUCTION FROM ASSESSED VALUATION
,, State Form 43709(R13/10-15)
*S ---, Prescribed by Department
flusrr UC77ONS: FEB 3 20 A le 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 sou s j. . E
Must be filed or postmarked with the County Auditor or County Recorder of the county where t•.1';Ie•. -i�-lTi►�i. [] County Auditor
located on or before January 5of the immediately succeeding calendar year. nI r 1�NTY AUDITFRountyRecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Count of ih9 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.
Appli (owner or contract buyer-see restrictions on terse side)
Taxing District I Key number l legal description `/'�'j[J Record number Page number
(21 v a6, - /`7'- w� -fot) -4oO. F 7 O - v .L3 .ol Y.-6 G
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage i 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?
9,0 00 0 ❑ Yes ❑ No
If no,what is his l 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 the property in question:Annually Assessed
0 Real Property ❑ AnnuallyAssessed
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5/
q„...„,z,..- ..„_,,i,c--- ,
Address of mortgagee or contract seller(number and street city,state,and ZiP code)
Name of assignee or other owner or holder of mortgage
DrawerAddress of assignee(number and street,city,state,and ZiP code)
NO........ • .
Does applicant own property in any If yes,what county? What Taxing.District? I ••.• •• ...
•• i
other county i
in Indiana? ❑Yes ❑No Card NO.
A person is not entitled to this deduction unless the person has a balance on the persons ••• •'••• unty
recorder's office(including any home equity line of credit that is recorded in the county raw.. .,...__,_
COUNTY AUDITOR
Deduction approved in the amount of. -
•
20 20 20 20 20 • 20' 20
Signatur of County Auditor • County • Date(month,day,year)
I/We certify under the penalty of perjury that the above a/ry....,e_______
going information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned111 property on pplication is filed.
_Sign y�(owner's full name) ( , C,/��q�(p Date(month,day,year)
`j ull resident addr of 'cant(number and street,city,state,and ZIP code)
1( )b 7 o n Sot 111 FI. 0 r A.4 04\1 --1--J-( Lill q c8
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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.