HomeMy WebLinkAboutMortgage_Bailey (17) } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i �'j7 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)
`— Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ . File Mark
To be filed in person or by mail. Fonn filed with:
Filing Dates' 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought El County Auditor
Must be filed or posbnarked with the County Auditor or County Recorder of the county where the properly is
located on or before January 5 of the immediately succeeding calendar year. 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CounyAuditor of the county
where the property is located dining the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Atiii t(own ar contract buyer- on reverse side)
1 ng ,f� ., p pry��j tie 1 V''1 'fie%/e , Q 2
T y`b X'�„`+�' . 26/ I b st tl3 4- 000 - I-I16 020 �ut3.Record number Cyr`,'
1Assessed' value of real property as of ,A ortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness un id as of Is the appliant the sole
assessment date,amend year assessment dale,amem year date of pl' legal or equitable owner?
,� 1 }�� � . ❑ yes ❑ No
If no,what is his/her exact share of interest? If owned with so ne other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below ,•- property in gquestionAnnualy Assessed
. /)j i MP b (IC 6-1.1-7)
Name of mortgagee a contract Seger )l s wKA t R - 7C
ciadi
Address of mortgagee or contract seller(number andn street,cr/y,state,and ZIP code) NOV 1 6 Z U I3
Name of assignee or other owner or holder of mortgage /a/eMiiSte-----
Address of assignee(number and.sheet city,state,and ZIP code) a O R
o�applicant own property in any .If yes,what county? What Taxing District? Has on property
dyed been requested If yes,state amount of deduction
in Indiana?ty ❑Yes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the,person has a balance on the person's mortgage or contract indebtedness 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 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 I contract buyer of the aforementioned property on date application is filed. .
XSignature(owners ruff name) Date(nnaNc day,year)
F __0 ent`rdd E a t( umber streetcih; a1S -cAnIP /
Person authorized by duyWWWexearted Power of Attorney or by IC 5-1.11-12-0.7 C•`/'_\ / -I-iv Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.