HomeMy WebLinkAboutMortgage_Barbour �s� r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
?: FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
■ f'� State Form 43709(R13/10-15)
j• Prescribed by Department of Local Government Finance F II JEJ
INSTRUCTIONS: File Mark
To be filed in person or by mail. MAY 0S 2017 Form fled with:
Filing Dates: 1) Real Property.Must be Completed and dated in the calendar year for which the deduction is sought
Must be fed or postmarlred with the County Auditor or County Recorder of the county where the •. •.,-.. ' ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year !
,� . .�i de ❑ County Recorder
2) v4ieiv /Manufactured Iy is located Homes not assessed as Real Property:Must file with the Co••r. :?r. R
where the property is located during the hve/ve(1?)months before March 31 Z(�1 ,..7r?�e it
See reverse side for additional instructions and quafrfrcatigps.
Appfuant(awn contract dryer- e resbr" on reverse side
•
T g Key number/legal description Record number Page number
H CV 7 4/10 e71
Assessed value of real propertylis of Mortgage/Contract indebtedness unpaid as of M /Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
5076ji 7 3 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If armed with someone other)
If name on record is different than that of applicant,indicate below. • Annually Assessed
\nnually Assessed
(IC 6-1-1-7)
Name of mortgagee or conlracte )p/']'�
Address of mortgagee or contract seller(number and
Name of assignee or other owner or holder of tamlgaye C
Address of assignee(number and street dry,state,and VP Ui'
II
Does other countyy applicant own property in any If yes,what county? — _
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person r the county
recorders office(nduding any home equity line of credit tic
Deduction approved in the amount of: Mai
20
i
Signature of County Auditor
IIIIIPPIIIt-
I/We certify under the penalty of perjury that the above and HH(yr- cram and
owner I contract buyer of the aforementioned property on dal �
Signature fu rnee/)c/�ct4 / Date(wowth,day,year)•F ✓ em address of applicant(nuummb beer-an-dd sheet,ay,state,and ZIP.:
C a 2 *Z. $ ill 'r$ s. I CO So , Pr C 1v., .L
` N 417670 .
Person authorized by duly executed Power of Attorney or by IC 6-11-12-03 Data(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for penury can include imprisonment up to My and a half years and a fine not to exceed 510,000.