HomeMy WebLinkAboutMortgage_Barrett (11) e•Q•!:; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
a FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R12/6-14)
°-,a�� Prescribed by Department of Local Government Finance
INSTRUCTIONS: 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.
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Must be filed or postmarked with the County Auditor or County Recorder of the county where the ❑ County Auditor
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located on or before January 5 of the immediately succeeding calendar year. N ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor o e ,f ,�1'
where the properly is located during the twelve(12)months before March 31 of each year the deduction is 48 . wor
See reverse side for additional instructions and qualifications.
Applicant(owner coot t yer-see restrictio n reverse side) FEB 2 5 2016
Taxing District rfumber/legal description �"-.. . - �� P.ge number
66-I - o5-4o3 -000. / 9- ��,�o�1���.�►::- r- ,713
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness ,.o._usx b nt me sole
Mardi 1,current year March 1,current year date of application legal r>t Egpable owner?
=50I 0vc) ❑ 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 o contract sell \ +P rn 3 (y
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Address of mortgagee or contract seller(num er 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 If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes ❑ ❑
No current year?
❑ Yes ❑No
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 fine 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 20 20 20
Signature of County Auditor County Date(month,day,year)
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/contract buyer of the aforementioned property on date application is filed.
Signature�(oowner's full name) Date(month,day.�:far�
_'�'�
Full re ident address of appli t(number and street,city e,and ZIP code)
l c k7c, 2
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.