HomeMy WebLinkAboutMortgage_Dunlap (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS aunty Township Year
' = *; FOR DEDUCTION FROM ASSESSED VALUATION �
,:f State Form 43709(R13/10-15) ,�,Stn. jai-Aire) c-�1
Y/20
1-III
? Prescribed by Department of Local Government Finance
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 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 deductor-r-_--,...•r,r. _
See reverse side for additional instructions and qualifications.
Applicant(owner or con bu r-see restricts on verse si ) atin-QaPi
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Twang istrict Key number/Iegaldescripti•rI dikijnt f—
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgag-I Contract indebtedn Iy (5)I X-0-,
assessment date,current year assessment date,current year date• =•licatio /�
,�20 o�s� 010 c,70—013
If no,what is his/her exact share of interest? If owned with someone other than spousd
If name on record is differentlhan that of applicant,indicate below:. Is the property in question:Annually Assessed
❑Real Prope s(. • l MobileyAse ss 6-1.1-7)
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Na rtgagee or contract seller
Addressmortgagee or seller(number and street c' state,and ZIP code)contract e k �1:
DEB 1 I '69
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) Tv A�®y t OK
nin ON COUN
Does applicant own property in any s,what county? What Taxing District? Has this deduction ben requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 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
Signs re ofcounty Auditor Cou Date(month,day,year)
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1/W certify under the pen f perjury that the above an regoing information is true and correct and that the applicant is a resident of Indiana and
ner l contract buyer of the aforementioned property on date application is filed.
Signature(owner's L me) Date(month,day,year)
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Full resident address of applicant(n lrber and street,city,state,and ZIP code) G� /
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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. _