HomeMy WebLinkAboutMortgage_Harper (7) lb�,ER,r=\ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� County Township Year
__ 0 FOR DEDUCTION FROM ASSESSED VALUATION
3.:.A11 State Form 43709(R13/10-15) GIBSON
;es
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
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 cated during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructi ns and qualifications.
Applicar ye r on tract buyer-see r strictions ory,re�e)
District %/""— 7 Key number//le al description Record number Page nu
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sed value of real property 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 app• tion legal or equitable owner?
/(J(l� ❑ 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 different than that of applicant,indicate below: — Is t property in question:Annually Assessed—
Real Property ❑AnnuaiiyNssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
: —Fe .
Address of mortgagee or contract seller(number and street city,state,and ZIP code) ' 4 yi
If r
Name of assignee or other ow holder off ortgage / � pQ D' �.
7/L4.46._
Address of assignee(number and eat,city state,and ZIP code) i / ,@90 ��co
�/�
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested ,..,, unt of deduction
other county on property for ik
in Indiana? ❑Yes. ❑No current year? ❑Yes ❑No •q6,
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is �• 'id 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.4'
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature onty Auditor County Date(month,day,year)
. I/We certify under a penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/,contract buyer of the aforementioned property on date application is filed.
Si pat e o ner's full am-) Date(month, ay,yea)
Full resident address o ppic n mber ntf street,city,sf f and ZIP code)
3o; sr irt1�,+. w 5�U1 Ile ( T N 4 ec
Person authorized by duly executed Po W r of Attorney or by IC 6-1.11-12-0.7 Date(month,day,year)'
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for Deriury can include imprisonment up to two and a half years and a fine not to exceed$10,000.