HomeMy WebLinkAboutMortgage_Kares p "•,:% STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
°'` FOR DEDUCTION FROM ASSESSED VALUATION
nn
e'A �e e
L'if State Form 43709(R14/1-20) ,i -
4Prescribed by Department of Local Government Finance
Ile Mark
INSTRUCTIONS: To be filed in person or by mail. D
ksc Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought..,, 3 02 ,9n� )<County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the coun where the pr,i�Gty is
located on or before January 5 of the calendar year in which the property( s ar f" due and payable. ❑ County Recorder
O
See reverse sid for additional instructions and qualifications. CO(y�TV
Applicant( er or contract buy�r-�e a r•strictions on reverse sid) ��/T
GZ C i' ��l c //7 OR
Taxi g Di ict , Key nu legal description Reco d number Page number
Assess 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 application legal or equitable owner?
/1 o COD ❑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: Xie property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 4...71
Q1.--Zid
Address of mortgagee or contract'seller(nu ber and street,citystatee,and ZIP c
Name of assignee or other owner o . ,mortga o i
a
dir
dtj
Address of assignee(number an.s ree,date,and ZIP code)
Does applicant own property in any If yes,s,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? III 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 —_I _20
Signatur f untyAuditor County
I/We certify under the penalty of perjury that the above and foregoing information is 6 a and
owner/contract buyer of the aforementioned property on date application is filed. T
Sig a re(owner'III m ) WTJdt I)r a
�ir er �O.• . .
Full res. .es of applicant(nu er ands et,city,s a -ti code a O•
Uo Car
1�
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 _,.,..,,ur,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for neriury can include imprisonment uo to two and a half years and a fine not to exceed S10.000.