HomeMy WebLinkAboutMortgage_Barr .^tea STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
b'.. ' FOR DEDUCTION FROM ASSESSED VALUATION
"� �, State Form 43709 /6e14) F L E
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. 1L 1 C Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction, Yuyyrtl 2015
Must be riled or postmarked with the County Auditor or County Recorder of the county where the property is •®OCounty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County A2 t. • _a n:ty ty
where the property is located during the twelve(12)months before March 31 of each year t':14.. !P(t1'1: •
See reverse side for additional instructions and qualifications. q. GIIBS�OrN� COUNT • 0!TOR
Applicant(owner o tract by r-see rest'c on reverse si¢ I ��' e.R.Q / �.u„GJ/
51-�Taxi�District A Key number/legal description Record n ben Page umber
`/p.( JA Z - 3-L/-/00 DD3 9770,7 7 l �v3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March urrent year date of application legal or equitable owner?
/a5V ❑ 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 Is the property in question:Annually Assessed
,'Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)_
Name of more a or contract seller
Address of mortgagee contract seller(number a;--
Name of assignee or other owner or holder of me 1 WI/ �" ""' ' ""-"
Address of assignee(number and street,city,st
Does applicant own property in any If yes,wh a been requested If yes,state amount of deduction
in In iana?y � '(ri ]Yes ❑No
in
other county ❑Yes ❑No
A person is not entitled to this deduction um ntract indebtedness that is recorded in the county
recorder's office(including any home equity t� hat is the basis for the deduction.
tr-3i, asp
Deduction approved in the amount of: (G
20 20 i(1km X� 15- l `� ,� 20 20
Signature of County Auditor �/�c' Date(month,day,year)
I/We certify under the penalty of perjury tl ___....,uuc anu correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioneu property on date application is filed.
Siiggnaattuurrree(oown`(er's rrull(r�i�gyrorly Date(month,day,year)
Fm resident add ess of applicant umber and street,city,state,and ZIP code) �'-�
ti ay 9"7 (=E . COi..�4-(F ZJ15 1^Cd �neI A �C) g 7 b 7 O
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 1 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.