HomeMy WebLinkAboutMortgage_Bailey (20) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
a,.. � County Township Year
if 'Y,, FOR DEDUCTION FROM ASSESSED VALUATION
�_`i :° Slate Form 43709(R13/70.15) T T T7 i\
Prescribed by Department of Local Govemment Hnance yAy qq �
l� IL.I F]i elf,'ALP
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought S E P 9 i(fi,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is L I County Auditor
located on or before January 5 of the immediately succeeding calendar year. .unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the unty
where the property is located during the twelve(12)months before March 31 of each year the.:. Ile.trite?, ;
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
Applicant wrier see resins on rse side)
T
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Key number/legal desai Record number Page number,
126 lA -o? fro/ - oo/. a 6 {�-� ,Z � /�0 338`(
Assessed value of real property as of Mortgage I 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 application legal or equitable owner?
89f100 ❑ Yes 0 N
If no,what is his I her exact share of interest? If owned with someone other than spouse,indhcate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
a�..(/ l Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /L
Address of mortgagee or contract seller(number and street city state.and ZIP code) /Z��EL —-
Name of assignee or other ovmer or holder of mortgage (J y KAT 14 CA, —
Add of assignee(number and street pry,state,and ZIP code)
1- SE -J- .t - /o , l0 .4-C_- —
Does applicant own property in any If yes,what county? What Taxing District? Has this ow..-__
Indiana?nom? ❑yes ❑No on property nt year? ❑Yes CI No I
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 me....,...ty
recorder's office(including any home equity line 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/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 toed.
Signal - name) Th./ Date(month,day,
9. 9_7,
Fun resident address of T'( and sheet aiy, /, ZIP y _
907 t, minor( Z./rid/7,1:n, E-N& 70
Person authorized by duly executed Power of Attorney or by 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street ply,state,and ZIP sale)
YYY The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .
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