HomeMy WebLinkAboutMortgage_Barney �:l STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE :cunt; ' ship Year FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110.15) �-r"( I
`— Prescribed by Department of Local Government Finance
INSTRUCTIONS:
UL I- 27 LUG/ 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
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Must be filed or postmarked with the County Auditor or County Recorder of the county ,f{} unty Auditor
located on or before January 5 of the immediately succeeding calendar year. GI B SON COUNTY AUDITCI County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
I Appbcantfwe or cbntraa buyer- rave side)
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T 6 Dp�m2 �pl;>,4, Difitt
Key number/legal description Record number Page number
s4 .4( R� 111 5 7 5 7 i s / -00 29. 6$.6 Gi 7 /7 c5/�d
Assessed rahre nt property y r as of 1 Mortgage Contract cement indebtedness unpaid as of date of application Co nct indebtedness unpaid as of Is applicant the snlo .
assessment I373&5 ❑ Yes ❑ No
If no,what is his l her exact share of interest? It 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
--f.-l-Real Property ❑ Annually Assessed
)4 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller t
, »Zed • . .. -Address of nnrtgagee or contact seller(number and street thy,slate,and ZIP code) _
2uEy (J r_c i--z_m
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) 64‘—t7-6
2
Does applicant own property in any If yes,what county? What Taxing DistricC. /7` '//O J/ or deduction
other
m Indiana? ❑Yes El No I irrenl year? �. .- /��`/bS
• A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness ma"-- .d in the county
recorder's office(inducting 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 Ned.
rre(owner's fun name) Date(month,day,year)
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Wes-Went address of applicant(number and street city,state,and ZIP code)
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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)
Me penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed t70 o(>n iimmillillillillill