HomeMy WebLinkAboutMortgage_Barthel STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•
FOR DEDUCTION FROM ASSESSED VALUATION
sa_ : Statte Form 43709(R13/10-15) ��yy M
F IeRulafic
Prescribed by Department of Lod Government Finance
INSTRUCTIONS:
To be filed in person or by mad. - Form fled with:
Filing Dates: 1) Real Property.'Must be completed and dated in the calendar year for which the deduction is sought. i
Must be tiled or posbnarked with the County Auditor or County Recorder of the county where the property hiss 9 'E' my Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufachaed Homes not assessed as Real Property.Must file with the County Auditor of the ,1 ( .
where the property is located dung the twelve(12)months before March 31 of each year the deduction�jb
See reverse side for additii on� ial instructions and qualificatoonns. 4. /� 'GGIIBBSONCOUNTYAIIf]ITOa
/ Key%ayber/legal desaiptmn
n . .w%.o 0702-7a T0-00 as— / O og '‘ 70n7b . y
Value et reed property as of Mortgage/Contact Indebtedness unpaid as of - Mortgage/Corurad indebtedness unpaid c
bidebtedrpaid as of Is the ard the sole
• date,aarend year assessment date,amend year date of aypfimfion /� legal or equitable owner?
jbyt�)2/� LJ[i ❑ Yes ❑ No
If n o,what S his I her end share of interest? If owned wind' /someone other than civvies,indicate with whom
if name on rand S ddfaent than that of applicant,indicate below. ` property In question:Annually Assessed
Real Property ❑ Annually Assessed
are �`y � �(//��y /7 //! - Mobile Home(IC 6-1.1-7)
Mane d mortgagee a contact miler l '/l-. /r / may,V
Address of mortgagee or contract seller(number and street,coy,state,and code)
Name of assignee or other owner or holder of mortgage ' •
Address of assignee(number and street,ray,state,and ZIP code) /�
ce�lQu") y 74/
Does applicant own property in any If yes,what county? . azumg District? Has this deducts('been requested If te amount of
other county on in �Indiana? ❑Yes 0 N • current ❑Yes ❑No
,n_hnn a-houorw on e person's mortgage or contract indebtedness that is recorded in the county
county recorder's office)that is the basis for the deduction.
\ f AUDITOR '
I'\--�9-'Y` \ �e Count Date(rnadh,day,year) .
f`
V Q Cv\o c • - - y, Q., rmalion is true and correct and that the applicant is a resident of Indiana and
is filed.
1 e \ (o_4 Date(month,dal:year)
lS__t od . a rr . w Y7039
n- '-- - 'L Date(month,day,year)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. _- .. __ _ .