HomeMy WebLinkAboutMortgage_Barton STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
-;;..- '-`7 StM Form 43709(R13/10.15) F yyy �--�
• Prescribed by Department of Local Government Finance {(� I L 0 �
INSTRUCTIONS: 19r.' M1kdetY'/.
To be filed in person or by mad. Form M with:
Flog Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought. S E P 1 1�Q 1/
Must be fried orpostmarked with the County Auditor or County Resorts rofthe county where the property is- '�J 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 �•� rder
�tyReca
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction:a .
See reverse side for additional instructions and qualifications. nissON COUNTY AUDITOR
Applicant • or.,.,, see ._,
aArican Tarim Dts/a Record 7 _
' (0 • • b a { o -oo I. 6 i -O 2 - 00
)
Assessed value of real property as of Mortgage/
Crnhact indebtedness tmpaid as of - Mortgage/Contract indebtedness unpaid as of is the appirard the sole
assessment date.aerent year assessment dam,arrant year date of app6tabon legal or equitable owners
at ❑ Yes ❑ No
If no,what is his/her exact share of interest? I If owned wifti someone other than spouse,Indicate with whom •
If name on record is different than that of appr:ant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobie Home(IC 6-1.1-7)
Name of mortgagee or contract setter
Address of mortgagee or contract setter(number and stee5�y,intend end ZIP code) /,/�.
Name of assignee or other owner or holder of mortgage \I ru\ 1 ( �I ••••.
J�rawef NO...
Address of assignee(number and sheet rdy,smte,and ZIP code)
applicant Does non property in any t yes,what county? - what Taint Gate wnt am of deduction
inmi na? Dyes 0 N •
A person is not entailed to this deduction unless the person has a balance _. ..,,,,neuness that is recorded in the county
recorder's office pc:Ite g any home equity fine of credit that is recorded: , ......nuers office)that is the basis for the deduction.
COUNTY AUDITOR " - -
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of CountyAmato, Carob Date(mordh,day,year)
I 1 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 aforemae//n�fi��ppnnS property on date application is filed.
(own fur name) n Date(month,day,year)
address of- 0, and sheet.nand ZIP nn
10 41 �Ledd�iM � x Ai.I. ft'�I,��ter s!► v V 762 7o
duty executed Power of ar b IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,Sy,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. _