HomeMy WebLinkAboutMortgage_Carpenter �E�"°4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
� _ _ FOR DEDUCTION FROM ASSESSED VALUATION
., 2� State Form 43709(R13/10-15) GIBBON
p'' --i Prescribed by Department of Local Government Finance
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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.
Applicant(owner or contract buyer-see restrictions on reverse side)
Y'o L -Qn C . 4 - % ei k - Car r,p(,-Eer
Taxing District Key number/legal description Record number Pa numb r
1\(\63(4 111 4 ° cz, a —ko— Co-- OO . —Cc ( 2• c2c)
Assessed value o-4-al property.1 f Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date, rrent year assessment date,current year date of application QO__ legal or,equitable�owner?
c12 . -Di, 0 0077 gyres ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
al Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller it
-C-----\) 0 r\. ‘).\ \ e__. a-0,x\(k. k_App ;
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ;
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Name of assignee or other a a ll C 9ca JO p4fl- . i- ✓�c (.
f, / / c 2 cif le?
Address of assignee(numbe Y r�`� 6t7��6�� ""C.
Does applicant own property /VVV„I 1 "' d6 ((% as this deduction been' u' -d Tfyes,state amount of deduction
other county """"" 1 property for • �
in Indiana? ❑Yes irrent year? ❑ Sat,
) ,
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
Sign re of County Auditor County Date(month,day,year)
Qz.
slr.„.j.....,
I/We certify under the penalty of perjury that the a ove a . . egoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on da - application is filed.
Signature(ow .full n e�) Date fh ��0'— 1
full rest• t-d ess.o ap/Lp nt(nu ber and treet c' state,and ZIP code) �// �C J
Per-on authorized by duly executed Power of Attorney or by I9)-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.