HomeMy WebLinkAboutMortgage_Martin (4) o,.m,,v, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION 1
'' •' `. C; State Form 43709 R14/1-20 xa'
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„B '' Prescribed by Department of Local Government Finance \ `
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INSTRUCTIONS: To be filed in person or by mail. C.Ok I. "l �l►.:��
Form filed with:
Filing Date: Form must be completed and dated in the calendjear for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
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' tr Taxing D ' t Kg number/legal description Record number Pa number,
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Co tract indebtedness unpaid as of Is the applicant'the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
it /So, 6ZS0.00 e<es ❑No
If no,what is his I 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: - I Is the roperty in question:Annually Assessed - -
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(number and street,city co
Name of assignee or other owner or holder of mortgage
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Address of assignee.(number and street,city,state,and ZIP code) r-
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Does applicant own property,in,�any If yes,what county? WrIVITax{ht'ta igk•� Has this deduction been requested If yes,state amount of deduction
int Indi ourjty ❑Yes Lie ! � .�V on propertcurrent year?
❑Yes ❑No
in Indiana. el:‘,' current year.
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
Signature of County Auditor 1101° County \ Date h,day yeacj1
I/We certify under the penalty of perjury tha and foregoing information is tr e nd correct and that the applic t is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) _ - - - - -- - - Date-(month;day,-yeatj
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Full resident address of applicant(number and str tt,city,state,and IP code)
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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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed_,•'I.
s.
RECEIPT FOR FILING STATEMENT OF MORTG C CT INDEBTEDNESS
Name of applicant of rt e or contra seller
Date filed(month.da,year) Amount of indebted ess ' _ ®. Taxing Distri t e2.)i rill rri
Key number/legal description � •,I, •y`r am✓r
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Signature of County Auditor ounty Recorder County Y 0 ^ 'Date(month,day,year)ea_ Si Cj
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