HomeMy WebLinkAboutMortgage_Hartley STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
is FOR DEDUCTION FROM ASSESSED VALUATION
\,;-c:"0 State Form 43709(R13/10-15) mil'+
-16
Prescribed by Department of Local Government Finance - l
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INSTRUCTIONS:
To arks•
,
be filed in person or by mail. Form
Filing Dates: 1) Real Property.Must be-complete]and dated in the calendar year for which the deduction is sought Fs di
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is I .ii County .uditor
located on or before January 5 of the immediately succeeding calendar year. /
G/ it �unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor •
where the property is located during the twelve(12)months before March 31 of each year the deduc —
See reverse side for additional instructions and g4alitications. ` (/STY
Applicant(own or ontract buyer-see strictions on reverse side) eolia\c4ek. ^ ���fJ ro
T ' g District Key nu /le description Re rd number Pa a ber
2 , ,^-- 9--� 2--00 0 .l00 -Ol9- • RO40 U 7
essed value of real props as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application /J legal or equitable owner?
7c 6 /0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is differentthan that of applicant,indicate below: Is property in question:Annually Assessed
Real 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) I'a//J
Name of assignee or other owner or holder of mortgage � //
Address of assignee(number and street city,state,an1 ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? H
other county o:
in Indiana? ❑Yes 0 No 0
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A person is not entitled to this deduction unless the person has a balance on the person's i M my
recorder's office(including any home equity line of credit that is recorded in the county reo
COUNTY AUDITOR
Deduction approved in the amount of: toe-
\-/ "‘ C/
20 20 20 20
—
Signature o o Audit County
1-6-
/We certify under th of per] that alblive and foregoing information is ti )_(-\\Jand
owner/contract buyer of the aforementioned property on date application is filed. I ___-
Signatu (o er Ina ) Date(month,day,yew)
F I dent address of app nt(number and street,city state,an P code)e ,-, re /- 0 / /J 7
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.