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HomeMy WebLinkAboutMortgage_Barrett ' 'w STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS r % FOR DEDUCTION FROM ASSESSED VALUATION County Township Year ",.:,,,_'`4� State Fonn 43709(R12/6-14) FILE „V 6 Prescribed by Department of Local Government Finance INSTRUCTIONS: JUL 2 2015 File Mark To be filed in person or by mail. . Form filed with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. Must be filed or postmarked with the CountyAuditor or County Recorder of the county w the County 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 withthe24Q8p141erj q'elktd©ITOF 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 tovmerodcontract b r- e restrid on re e e e 1aPrg Dis Key robe legal description Record number Page number '11 ,Q � 0(�-17-aR-tco-col .9tFo-oal ao/5 as7y Assessed valu real as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole March 1,current year March 1,curre t year date of application legal or equitable owner? • /)(D000 ❑ 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 mortgagee or contact seller {r\ // �OM� Z/67--e-l) •Address of mortgagee or contract seller(number and street,/cJnity,ss\�tate,and ZIP code) ( Name of assignee or other owner or holder of mortgage Address of; --and street, state,end ZIP code) Does appli lll.a 1gei- i\r , r - - 1 Taxing District? Has this deduction been requested If yes,state amount of deduction other coon �j1.-I on property for in Indiana' current year? ❑Yes ❑No A person Ca 1-d� balance on the person's mortgage or contract indebtedness that is recorded in the county recorder' 1�'�. acorded in the county recorder's office)that is the basis for the deduction. COUNTY AUDITOR . Deduct 20 20 I 20 20 20 20 • • Signature o ',ty Auditor D , County �/ � Dave(month,day,year) am^{ /�,1 � Or)—Od-4S' I 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 I contract buyer of the aforementioned property on date application is filed. Signature( ers full - Date(month,day,year) Cull y resident address o pprcant(number and street,city,state,and ZIP code) ' S g 3 (�leOdo� Luny pwe.nsv:Ue iN 4'1UzU 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 510,000. _....rs