HomeMy WebLinkAboutMortgage_Barth STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
��Ai �,i FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/609) 1 ItLi
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: ._.;•:• ,'. ,
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months h
before March 31 of each year the deduction is sought - I •R1 ii':ryy Recorder side) Of See reverse side for additional instructions and gqua�li/fi{ccaations. �l///�/1 ...y/-�) GIBSO : . I .
Applicant •
/.-laraonMarl6uyeV ��$,,(�//�^^7 //�a /O /'tom
Taxing Pith/ V/ - jQ-3/-s3-GYM. 2&?- cog i Fp no
Assessed value of real property as of Mortgagge/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appliicant the sole
March 1,ascent year Ma 1,anent year date o ep�prrr gn legal or equitable owner?
/ (/ , ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone outer than spouse,indicate with whom
If name on record is different than that of applicant,Indicate below. IIss the property in question:Annually Assessed
I l]�Real Property ❑Annually Assessed
• /IT1 Mobile Home(IC 61.1-7)
Name of mortgagee or contract setter / a /�fJ
Address of mortgagee or contract setter(number and street,thy.state,and ZIP code) /_/��•/jv���nf
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,my state,and ZIP code)
6// ZS 'Vie
wh
Goes applicant own property in any other If yes,what county? , at Taxing District? Nis deduction been requested on property
county in Indiana? for cent yea ?
❑ Yes No
❑ Yes ❑ No
COUNTY AUDITOR
20 Drawer NO M.�.115 - 20 20 20 20
Sgna1ur Card NO. 684/R , County Date(rash,day,year)
4,,I I c+r coo• ng information is Vie and cored and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
\I\ Signature ,wners lug name) & Data(month,day,year)
Fu resident••• of • - t(number and street dry,state,and ZIP code)
70/ 1)iv6of. oDeH Cr /2/4e}65T,0 0T/ /4) X17439
Person authorized by dbly executed Power of Attorney or by IC 6-1.1-12-0.7 f Me(month,day.year)
Address of authorized person (number and street,say.state.and ZIP code) •