HomeMy WebLinkAboutMortgage_Barrett (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ,.
"t''-` ?; FOR DEDUCTION FROM ASSESSED VALUATION •• '?t Township Year
�° State Fonn 43709(R13/10-15) -FIL ,
<S- Prescribed by Department of Local Government Finance S
INSTRUCTIONS: N3V 3 2011 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is-> 4i
Must be filed or postmarked with the County Auditor or County Recorder of the co p II f.,*petty is " I3County Auditor
located on or before January 5 of the immediately succeeding calendar year. I. • `.. r •&�o 'OR
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with , - •• , Ifz&>?ot tie county aunty Recorder
where the property is located during the twelve(12)months before March :.,'- �- year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant( orwconnt``aaQ''t b' -see restrictions on reverse side) (�
(
� ��AC A t �61J131Q
Taring District Key number/legal description Record number Page number
`i`( alp- n - la- leb - 001 . 53.77-0 Q0/ •y 554
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date current year date of application legal or equit tie owner?
3-000' ❑ Yes ❑ No
If no.what is his/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 property in question:Annually Assessed
QReal Property ❑ Annually Assessed
Mobile Fbme(IC 6-1.1-7)
Name of mortgagee or contract seller !//
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage
Drawer NO... 0.... .
Address of assignee(number and street,c+ty,state,and ZIP code)
•
•
Does applicant own property in any If yes,what county? What Taxing District? Card NO. (-/35(--e of deduction
other inIndi Indiana? (6-' -/7 E 5O coo
in Indiana? ❑Yes ❑NO t r
A person is not entitled to this deduction unless the person has a balance on the per,.,.,,,,,,,,.yam ,,,,•.n ...a.wo..,.,,,.J in the county
recorders office(notuding 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 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/contract buyer of the aforementioned property on date application is filed.
Signature(owner's tub name) Date(month,day,year)
X dr
FWI / address of applicant(number and street city,state-and ZIP code)
■i 6o 67 S p/7-RRbf-l- L/'jr.,B O-'cr-Stri ctei n, t12 bb r
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10,000.