HomeMy WebLinkAboutMortgage_Monroe ,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
' , '1 P` State Form 43709(R13/10-15) J0� 2 0
..a , ,, Prescribed by Department of Local Government Finance
INSTRUCTIONS:
File Mark
To be filed in person or by mail. Fo 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 properly 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.
Apnt ner or con b r see reslrig�ygs on reverse side)
X`N1 NO O(WO L
Ta og,Bitstrict Key number/legal description Record number Page num er
Jso - Z&-Z3 --)L -IoQ-040 ) % ciz 02_1/44 . 2 1-f
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortg e I Contract indebtedness unpaid f Is the li t th soil
assessment date,current year assessment date,current year date a i n legal r i ble owner?
, � • Yes ❑ No
If no,what is his I her exact share of interest? If owned with meOne other tt(an sp use,indicate with whom
If name on record is different than that of applicant,in mate b low: I property in question:Annually essed
eal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of rtg ee or con eller
A.
Address of m e or contract seller(number ands state,and ZIP code) FILEr a
tiboc J
Name of assignee or other owner or holder of mortgage
Address assignee(numberZIPFEB 202 O i Ad s of and street city,state,and code) Q
Does applicant ownproperty in an If yes,what county? What TaxingDistrict? Has ._ +' a aer).
c. OsPP Y ro 1 c + 3' "3, �l 1 f
other county on pro ?"` f•1p�,��� I►
in Indiana? ❑Yes 0 No curren year? El-11 s1/T ra `./�
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedrlbsrt is recorded in the county
recorder's office(including an r ome-. Hy line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
/ COUNTY AUDITOR
Deduction approved in th=amount oil
•
20 20 rr� ' 20 20 20 '. 20' 20
v
Signature of County AuditorVA � I�Ngol ____-- County Date nYr y (20 .
Qt•
� ' zi3
I,We certify under the pen- v - jury that the ab egging information is true and correct and that the applicant is d resid nt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owne name) Date ono�, e>Pr)
/yam 2-
FulpOUd resident cress paPplicant;amber and��treerl state, n ZIP code) , 3rn
Peututhhoriz duly executeded Power of Attorney or byiC 6-1.1-12-D.7 r \I 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.