HomeMy WebLinkAboutMortgage_Baker a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
:!- State Forth 43709(R13/10-15) F i L �1 ..
Prescribed by Department of Local Government Finance J®pLJ.'J.
INSTRUCTIONS: Rte Mark
To be fled in person or by mai rh,,I�ff11t/- pp oonn Form bled with:
Firm Dates: 1) Real Property:Must be completed and dated in the calendar year for whidh'he d2duttbtl ISsought.
Must be filed or postmarked with the CountyAudittor or County Recorder of the where the re is \R County Auditor
located on or before January 5 of the immediately succeeding calendar - county property
2) Mobile/Manufachned Homes not assessed as Real Property.Must file nr: ';,-.4rf: • of the county County Recorder
where the property is located during the twelve(12)nandbs•- - .•"b }.ti y N• .deduction is sought
See reverse •1.a for addtional instructions and qualifications. ' •• • + Y AUDITOR •
Applicant ... . . ... ....buyer-see -•. on side)
• I • YVC sa
r Key;limber I/ll�lJndesm pt on Recoil page number
� t I. -i 4 -� -doh. c��—co—� � s
value of prapet'.y as of t Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is Me applicant the sole
r?t dais,auren yam da�,ymaptyeai _ sate of appli anon legal or equCable owner?
l/..• O i(wX�o ❑ Yes ❑ No
If no,what is his/her end share of interest? / If owned with someone other than spouse,indicate with whom
If name on record is different than that of aunt,indicate below. Is the property in question:Annually Assessed
• ❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract saner \Min /;°
t(11-2Y 1vl J
Address of mixbregee or cmhad semi(number and street oily,state,and ZIP code)
Name of assignee or other owner or holder of mortgage '
A KO-. E
B A R BEC L
C What Taxing District? Has ties deduction been requested If yes,state amount of deduction
_u current ❑Yes ❑No
A r s a balance on the person's mortgage or contract indebtedness that is recorded in the county
re / '75 recorded Anty recorder's office)that is the basis for the deduction.
COUNTY •
t
20 20 20 20 20 20 20
Signature of County Rudder 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/contract buyer of the aforementioned property on date application is fled.
$Igrahue(owm,fs fuG name) Data(month,day,year)
W. 9 dd% .7.2Y- dI ,evi /.G{�"//P,-°rn e/74( 4�
PPerson authorized by duty executed Power of Attorney or by IC 6-1(712-0.7 Date(month,day.yea)
Address of authorized person (number and street,a 7y,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.