HomeMy WebLinkAboutMortgage_Hancock (4) 40 gr•N STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
• = ''% FOR DEDUCTION FROM ASSESSED VALUATION
0 •? '-. -- State Form 43709(R12/6-14)
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..q""" , 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 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 r(e t bons on reverse side"
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Taxing `
Dis Key number/legal description Record number Page number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Conyct indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
�!f 670 ono , 0 D Ifi es ❑ 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 perry in question:Annually Assessed
^ ro �'.,I: An MobilnuallyeHome Asse(IC ss 6-1.1-7)
F Ied
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N tract
of m rtgagee or tt seller &it,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 020
AUG7 2
Name of assignee or other owner or holder of mortgage `?n6,
Address of assignee(number and street,city,state,and ZIP code) IBSON COUNTY AUUt I OR
Does applicant own property in an If yes,what county? What Taxing District? Has this deductionG been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes o 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
Signature of County Audit° County \ �� Date(mo, ayiyea" l�
I/We certify under the penalty of perjury that the a6 ve and foregoing information is true nd correct and that the applicant is a reside of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature,( ners full nam L���1 /104.40
Date( f , a,y 4-2 vVe/ vv I 1 L/ b, /w/` `
Full resident ddress of app' nt(number and street,city,state,and ZI- ode)
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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)
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