Free 43709.FH11 - Indiana

Reset Form

STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R11 / 6-09) Prescribed by Department of Local Government Finance

County

Township

Year

INSTRUCTIONS: To be filed in person or by mail. Filing Dates: 1) Real Property: Must be completed and dated in the calendar year for which the deduction is sought. Must be filed with the County Auditor or County Recorder of the county where the property is located on or before January 5 of the immediately succeeding calendar year. 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) Taxing District Assessed value of real property as of March 1, current year If no, what is his / her exact share of interest? If name on record is different than that of applicant, indicate below: Key number / legal description Mortgage / Contract indebtedness unpaid as of March 1, current year

File Mark
Form filed with:

County Auditor County Recorder

Record number Mortgage / Contract indebtedness unpaid as of date of application

Page number

Is the applicant the sole legal or equitable owner?

Yes
If owned with someone other than spouse, indicate with whom Is the property in question: Annually Assessed

No

Real Property
Name of mortgagee or contract seller Address of mortgagee or contract seller (number and street, city, state, and ZIP code) Name of assignee or other owner or holder of mortgage Address of assignee (number and street, city, state, and ZIP code) Does applicant own property in any other county in Indiana? If yes, what county? What Taxing District?

Annually Assessed Mobile Home (IC 6-1.1-7)

Yes

No COUNTY AUDITOR

Has this deduction been requested on property for current year?

Yes

No

Deduction approved in the amount of:

20 ______
Signature of County Auditor

20 ______

20 ______

20 ______
County

20 ______

20 ______
Date (month, day, year)

20 ______

I / We certify under the 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.
Signature (owner's full name) Full resident address of applicant (number and street, city, state, and ZIP code) Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Address of authorized person (number and street, city, state, and ZIP code) Date (month, day, year) Date (month, day, year)

RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Date filed (month, day, year) Key number / legal description Signature of County Auditor / County Recorder County Date (month, day, year) Amount of indebtedness Name of mortgagee or contract seller Taxing District

INSTRUCTIONS AND QUALIFICATIONS
Applicants must be residents of the State of Indiana. Applications must be filed during the periods specified. Once the application is in effect, no other filing is necessary unless there is a change in the status of the property of applicant that would affect the deduction. Note: A new application must be filed whenever a loan on real estate is refinanced. This application may be filed in person or by mail. If mailed, the mailing must be postmarked before the last day for filing. Any person who willfully makes a false statement of the facts in applying for this deduction is guilty of the crime of perjury and on the conviction thereof will be punished in the manner provided by law. The deduction equals $3,000, one-half of the assessed value of the property, or the balance of the mortgage or contract indebtedness as of the assessment date, which ever is least. Authority for signing a deduction application may be delegated only by an executed power of attorney or by IC 6-1.1-12-0.7. Signature of only one spouse is required for filing, when owner is a husband and wife in a tenancy by the entirety. An Indiana resident who was a member of the United States Armed Forces and who was away from the county of his residence as a result of military service during the time of filing must file a claim for deduction during the following year in which the individual is discharged from military service. A contract buyer must submit a recorded copy or recorded memorandum of the contract, which contains a legal description with the first statement filed for this deduction.