HomeMy WebLinkAboutMortgage_Barrett (9) . .,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
',YZ- FOR DEDUCTION FROM ASSESSED VALUATION
r--
":= "_,'y State Form 43709(R12/6-14)
7 Prescribed by Department of Local Government Finance
INSTRUCTIONS: ti, Ma I 1'
To be filed in person or by mail. 1-!`-'pr-�-
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 County Auditor or County Recorder of the county where the property is MAY 2euWv Auditor
located on or before January 5 of the immediately succeeding calendar year. I County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sou.
See reverse side for additional instructions and qualifications. , ' q'l1//:
nt eror contract -seere sonrevers side GIBSON GOU TY AUDITOR
I
App nab � I X)a,Ja4 Q. .
District Key Fiber/legal description Record number Page n
/vt vsby//& 6-/ /o -ooh O. ,. 5-- c acia /4&'�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract inde tedness unpaid as of Is the applicant the sole
March 1,current year March 1,anent year date of application legal or equitable owner?
❑ yes ❑ No
I
If no,what is his/her exact share of interest? If owned with someone other than(cause,indicate with whom
If name on record is different than that of applicant,indicate below: \Is the property in question:Annually Assessed
>i(Real Property ❑ Annually Ascacsed
/ ` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller � /��7 )
Address of mortgagee or contract se, 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 ZIP code)
Does applicant own property in any If yes,what county? What Tax to amount of deduction
other county Q f
in Indiana? ❑Yes ❑No �/�p/�� IV/(„�I
A person is not entitled to this deduction unless the person has a balm - - r recorded in the county
recorder's office(including any home equity line of credit that is recore rU I �en c/ r f fuction.
Deduction approved in the amount of: )
20 20 20 ''v{ ( coo /U-/�94 20
Signature of County Auditor - County Date(month,day,year)
'r W 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.
A.. Si ure(owners full name) Date(month,day,year)
}. c...-eil1i
ull resident address of appfcan (number and street,city,state,and ZIP code)
/03 w W,9c/ve— C A 0wc-,vs 1.//c.c r j At 4.4 ?a c
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$10,000. _