HomeMy WebLinkAboutMortgage_Weales (2) �.0-n;Fk:-q. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
7° FOR DEDUCTION FROM ASSESSED VALUATION
"� "r State Form 43709(R13/10-15)
�'���;'�' Prescribed by Department of Local Government Finance 6),, ,st,r)
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 X 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.
Applj a t(owner or contract buyer- ee rest'ctions on reverse side)
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Taxing District Key number/legal d scriptio Record number Pag n
�C :4 �r`n r I l d,p3-Dbl ••St)) o0-7 20�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the so e
assessment date,current year assessment date,current year (laof appation legal or equitable owner?
(� //IV�[_,Il' DOI) •00 rYes ❑ No
If no,what is his/her exact share of interest? If owned with someon,ather than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mo gagee or contract eller f Gc \ y t* x,
_ 4 ,litoi-k) WA e,t0,_A-ii hAmK
Address of mortgagee or contract seller(number and_,tr_et,city. 1.ate,and ZIP code)
Name of a signee or other owner or holder of mortgage , FEB ,';y
Address of assignee(number and street,city,state,and ZIP code) , .::( '
Al i-OR
Does applicant own property in any If yes,what county? What f in requested I y te(AaNnt of'de, n
other county GI13
in Indiana? ❑Yes .lo es ❑No
A person is not entitled to this deduction unless the person has a b, Ict indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is rec ��l (ON
is the basis for the deduction.
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Deduction approved in the amount of:
20 20 20 20 20 20 20
Sig ur=of County Aud}tQr 4/1 County Date(month,day,year)
L >�AC. i ( kb ism-\ 2: )2-2D2-0
1/We certify under the penalt of perj that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of th Diem Toned property n date application is filed.
Signature(owner's full name) / `—�J�2(�� Date(month.day.year)
a-le-Do�
II resident address of a plicaninumber and scree city,state,and ZIP ode)
Person authorized by duly executed Po er of Attorney or by IC 6-1.1 12 0.7" .1 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
Tha nanaltiac fnr nerinn,ran inrinrfa imnricnnment tin to two and a half vear.s anti a fine not to P.Yreedd.P,1 n nnn