HomeMy WebLinkAboutMortgage_Bartley (2) ,„. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
°a FOR DEDUCTION FROM ASSESSED VALUATION
\‘.,'� Y- State Form 43709(R12/6-14)
� Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. 3 - m., ,h:
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sough _.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prope y is ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. n CCounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co / u
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(ownconiract buyer-see nti o everse side) J I1,.,• ,,,9$
rblJl GIBSONN CWO"U"1NTY'4^A'U ITOR
Taxing District Ke umber legal scription Record number age number
a . • 13•aov• Dot. Ba 't-oa4 . i4 rSy7.S
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of�Mortgage/Contract indebtedness unpal,.as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
S01Orb ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom I
i
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
Q ,, -- .. aa -- __
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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.nn--'-'-
Does applicant own property in any Drawer \O•••••• Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? LI Yes ❑Noq 7� current yeah ❑Yes ❑No
r
A person is not entitled to this de. O / ••••,t-..t--.. .•• • 's mortgage or contract indebtedness that is recordded in the county
recorder's office(including any hr Card tcorder's office)that is the basis for the deduction.
R i
Deduction approved in the amount of: I
20 20 20 20 20 20 • t 20
Signature of County Auditor County 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 bu er of the afore -ntioned pnperty on date application is filed.
S n re w er's f,t me) / ) _, Date(month,day,year)
ull rest ent address of applicant(number and street,a�'ate,and ZIP code)
-.1066 E \asb S ' actle . 4(1639
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.