HomeMy WebLinkAboutMortgage_Bartley STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
kirrItititi FOR DEDUCTION FROM ASSESSED VALUATION
- State Fum 43709(R13t 10-15) ' ,Prescribed by `,
.I !,i
y Department of Local Government Finance �
INSTRUCTIONS: File Mark
To be filed in person or by mad NOV 1 0 Otraed with:
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 pmpert/is County Auditor
located on or before January 5 of the immediately succeeding calendar year. '
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auddor of the 'Recorder
where the property is located dump the twelve(12)months before March 31 of each year the d (g ANT" AUDITOR
See reverse side for additional instructions and qualifications.
Appdican or contract see restrictions on reverse side))-
W � Y//'f'tA%Cr .1
Ta>�g D' Key number/legal description Cj' Record number Page number
(/1 a 6,3- a.3 - boo - ooi. 5,g - oo6 ao/(o yfoc(
Assessed value of mar properly as of Mortgage/Contract indebtedness unpaid as of - Mortgage i Contract indebtedness unpaid as of Is the applicant the sole
assessment dab.arrant year assessment date,amen year date of application legal or equitable owner?
1049 So 0 0 Yes 0 No
If ro,what is his/her exact sham of interest? If owned with someone other than spouse,Indicate with whom
If name on record is different than that of applc ant,indicate below. Is the properly in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-14-7)
Name of mortgagee or dated setter s/3 _ _—
—
Address of mortgagee or contract setter(number and street city,state,and ZIP code)
..... ...
Name of assignee or other owner or holder of mortgage
Drawer 10..../�..f�'././. 'L.ILI� —
A of assignee(number and street,crly,state,and ZIP code) • Card NO. ..........•O•`
FAT NcJ a3 _ ? - 9 • S. o .4 L. . .
Does applicant own property in any If yes.what county? what Taxing District? Has this creauction been requested If yes,state amount of deduction
� ? ❑Yes ❑No - on property ❑Yes El No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the county '
recorders 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 • -
Dedudian approved in the amount of
20 20 20 20 20 20 20
Signalize of County Audit r County Date(month,day,year)
I I We certify under the penalty of per uiy 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.
X (owner's MS_ Date(rim N.day year)
F resident addresber and sheet city,state,and ZIP code)
9X3.2 Cr" f 91(c PI �u a.A.Ho..,/ (AL/ -14/ /ir7LGo
Person authorized by duly executed Power ofAttamcy 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 penury can include imprisonment up to two and a half years and a fine not to exceed$10,000.