Indiana Statement of Mortgage or Contract Indebtedness for Deduction from Assessed Valuation

Statement of Mortgage or Contract Indebtedness for Deduction from Assessed Valuation
43709.FH11
Reset Form

STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION

Township

County

Year

State Form 43709 (R14 / 1-20)

Prescribed by Department of Local Government Finance
INSTRUCTIONS:
Filing Date:

File Mark

To be filed in person or by mail.

Form filed with:

Form 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
located on or before January 5 of the calendar year in which the property taxes are first due and payable.

County Auditor
County Recorder

See reverse side for additional instructions and qualifications.
Applicant (owner or contract buyer - see restrictions on reverse side)
Taxing District

Key number / legal description

Assessed value of real property as of
assessment date, current year

Record number

Mortgage / Contract indebtedness unpaid as of
assessment date, current year

Mortgage / Contract indebtedness unpaid as of
date of application

Page number

Is the applicant the sole
legal or equitable owner?

Yes
If no, what is his / her exact share of interest?

No

If owned with someone other than spouse, indicate with whom

If name on record is different than that of applicant, indicate below:

Is the property in question: Annually Assessed

Real Property

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

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
Yes
No
in Indiana?

If yes, what county?

What Taxing District?

Has this deduction been requested
on property for
Yes
No
current year?

If yes, state amount of deduction

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 ______

Signature of County Auditor

20 ______

20 ______

County

20 ______

Date (month, day, year)

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)

Date (month, day, year)

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

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 $10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant
Date filed (month, day, year)

Name of mortgagee or contract seller
Amount of indebtedness

Taxing District

Key number / legal description
Signature of County Auditor / County Recorder

County

Date (month, day, year)

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.
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.
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed $10,000.
The assessment date for real property is January 1 starting in 2016 and January 1 for mobile homes assessed under
IC 6-1.1-7 starting in 2017. The assessment date for mobile homes assessed under IC 6-1.1-7 is January 15 in
2016.