HomeMy WebLinkAboutMortgage_Bartley (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Presabed by Department of Local Government Finance E i 1
INSTRUCTIONS: IT .".' IeMA.r,
To be filed in person or by mail. Fo led with:
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought M is
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 7 121 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 Auditor of the•ll ty • a - Recorder
R ii
where the properly is located during the twelve(12)months before March 31 of each yearthe deduction . •• V"'9::
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
App nt(owner or,1 �/J sbttions on reverse spte) �] Q -7 r Q nu T . DL t✓rLaerA nu 62/I -1 3 _ �`a ce -p 1 . O 5 7 -o �oi ( Pagc7 /�
value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
nt dam,curterrt year assessment date,current year date of application -
legal or equitable owner?
•36(p 00 () ❑ Yes ❑ No
If no,what is his I 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 the m question:Ann Assessed
eat Property ❑ AnAssessed
• ,Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract K ��
l/x� (Jz!/Y �
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage E'1 4 ' _
f ' (� �Q�� �e q 1- 1i
Addr of assignee(number and street,city,state,and ZIP code) l- v` c L 1'J�
pT NE 13 - 9 - io 7. Y6,34- c y 1 —
Does applicant own property in any If yes,what county? What Taxing District? Has th W D \`^-tr. l-pgy•-S ihC_
other county on prc ^� p _
in Indiana? ❑Yes 0 N currer a01l -Sc(z d 3tc LSb .O0
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cone-au,r,um..o...,_._-.-_._ 'y
recorder's office(including any home equity line of credit that is recorded in the county recorders 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 filed.
"1/4_\ SignAyfre( Cs f j arye) Date(month,day,year)
( resident address/of applicant(number street city,state,and ZIP code)
0-a66 E /,9, 1,1,441-t hs14ctt s v At V'M
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Person
of authorized person (number and street city,state,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._