HomeMy WebLinkAboutMortgage_Barron . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-���rrr...,,, FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10.75)
— Presaibed by Department of Local Government Finance
INSTRUCTIONS: Filearrk�
�
To be filed in person or by mail. API 74111017
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 property is ❑ County Auditor
located on or before January 5 of the invnediately succeeding calendar year. ■ 4 ,. fir --..rder
2) Mobile/Manufactured Homes not assessed as Real Property:Must Me with the County Auditor of the county ,. 2,...—x jrirt�_,,
where the property is located during the twelve(12)months before Mardi 31 of each year the reducti°17 NW-y COUNTY AUDITOR
See reverse side for additional instructions and qualification.
Applicant(owitgcontra 11. .ru a verse ) \a
Taxing District Key-n umber/legal description Record number Page number
� � a� — 13 as - l D D eon , 5 any' d_ C)( 3—1 ■g ,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment daa,current year assessment date,current year date of application legal or equitable owner?
5 .*r Doc 0 Yes ❑ No
If reexact share of interest? ' If owned with someone other than
spouse,indicate with wham
If name on record is different than that of applicant,indicate below- Is the property in question:Annually Assessed
{ sal Property ❑ AnnuaflyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller -�__
Address mortgagee or contract seller(number and street,city,state,and ZIP code) `,Lp\p o`,r,* .'.('
Name of assignee or other owner or holder of mortgage N `1�v4„�rt �, r c. I
Ev w�S q.1 l l'. �e e.Y o_. em-e4iC
Address of assignee(number and street city,state,and ZIP code)
h\O v
-� 41'5- \ b00-O0
C .
Does applicant own property in any If yes,what county? What Taxing Dm...,...a 0 I�° ' 'S 1'o O_-1_ 1 L mount of deduction
other county onpropeny>w l l
in Indiana? ❑Yes No cunantyear? oyes ) t4o I
A person is not entitled to s deduction unless the person has a balance on the person's mortgage or contract btedness that is recorded in the county
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 ot.
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/contract buyer of the aforementioned property on date application is filed.
Sign's_' -
-
rtrdl n.: J Date(month,day year)
: (number ann+dd�street state,a/n\t�code) �,(y�
Person curl executed eS2f a� 17 6 ' ,7ICJ5O / " 47c 9
duly Attorney or by IC 6-1.1- -0.7 /
•
Address of authorized person (number and street city,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.
•