HomeMy WebLinkAboutMortgage_Barrett (12) f,a^ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County ownship Year
FOR DEDUCTION FROM ASSESSED VALUATION p
'^ State Fenn 43709(R13/10-15)
Presaibed by Department of Local Government Finance
INSTRUCTIONS: Age • ark V
lb be filed in person or by mail. o- ,d,:leth:
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 whom the ptpperty ' , . ■ County Auditor
located on or before January r
ary 5 of the urertiatety succeeding calendar year ‘3 18S010,,,, d7da),T4:1 ..rder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county Ot/
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought - r+lT
See reve --.= for additional instructions and qualifications. OR
App"?- (o- eror.. .:ct buyer-. -4 reverse side) //
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T-•v ,r . Key mr /MO descriptioi67-0,4 / Page number
0/ „jo - Sao -coo. � rte-/ X 9/7/
Assessed value of real as Mon gage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of apNeon legal or equitable owner?
/CC2 000 ❑ 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 e property hi question:Annually Assessed
�7] Real Property ❑ Annually Assessed
/v Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ///give J(
Address of mortgagee or contract seller(number and street city4 state,and ZIP code)
Name of assignee or other owner or Muter of mortgage //
T c G,) do - 3-//
Address of assignee(number and street sty,state,and ZIP code)
3Vo /9c
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 cu � ❑imInda ❑Yes ❑No rrent 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(inducting any home equity line of aedit 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.
:iliaSignature(awrrefs nil name) Date(month,day,year)
c:'� 1J._l�A
nFull resident address of applicant(number and street aby,state,and ZIP code)
,9, q1 SS- n W Cl us)CAc,\fille_ INI 47 (c15s
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,slate,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. •