HomeMy WebLinkAboutMortgage_Barrett (13) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s,., 71
County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
'f'� e
File Mark
INSTRUCTIONS:
lb be filed in person or by mail. F filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ 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 March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
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T - District Key number/legal description Page n m r
1 0 1\ , 2-6 -1� Zo Zo-0 -00D .jamL1 -0z1' `�n `l 5036
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is a nt the sore
assessment date,anent year assessment date,current year date oQaP i`� i legal equitable owneR
l s_l CC? b Yes ❑ No
If no,what is his I her exact share of interest? If owned with eone than spouse,indicate with whom
If name on record is different than that of applicant,indicate below- 'Is e property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r . /
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Address of mortgagee or contract seller(number and street city,state,and ZIP code) I I B D
Name of assignee or other owner or holder of mortgage JN
1cr 1 7 ?nip
Address of assignee(number and abed city state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has j(ieilint•y erequested If yes,state amount of deduction
other in Indiana?nty ❑Yes ❑No G( oaen Ins- Yesi lrlt4e
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or conbact 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 perjuy that the above and foregging information is true and correct and that the applicant is a resident of Indiana and
own/-r/contract buyer of the aforeme"ned property on date a(r.7J'cation is filed.
Y •...T e(ow Date(mo rh,day ye
1 lCXr � Ao1 f 221%i/ 12- 1-11l • .
F -�at ddress of applicant(numbe and street ary,state,and Zit —1 e) �� ' r . i�
Person authorized by duty 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 perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.