HomeMy WebLinkAboutMortgage_Baker ,�,6!•. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' -`��� _ FOR DEDUCTION FROM ASSESSED VALUATION _1 II 1 n�1,/f�
-zz State Form 43709(R13110-15) 1 y1\p1 O I/1 ,J fr 1 M
`,, t„' Prescribed by Department of Local Government Finance 1�-' \\\w l ll? liV` I i
INSTRUCTIONS: ! File Mark
r
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 properly 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.
Appli.,12 ow er buyer-see i lion;I on reverse side)
COA G /
0`Distract VW cI G �Key) tuber/legal d;c gpon-0Q I ! Rer� �rrib� Page n0
Assessed value of real pro,pe as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the appi nt the sole '
assessment date,current y assessment date,current year date apli do legal or 'table owner?
�� Yes ❑ No
If no,what is his 1 her exact share of interest? If owned witromeoneAther than spouse,indicate with whom
if name on record is different than that of applicant,indicati the property in question:Annually Assessed
O _ 5 ,/_3 • Real Property 0 Mobilessed
Annually
(IC 6-1.1-7)
Name of mortgagee or co tract seller of `�
FYt, "'kk Drawer NO -fit/ .
Address of mortgagee or contract seller number and sires
Name of assignee or other owner or holder of mortgage Card N O. r
Address of assignee(number and street,city,state,and Z. ____, O C+ 3 g Zu/9
Does applicant own property in any If yes,what county? What Taxing District? Has this dedu • f yes,state amount of deduction
other county on p
in Indiana? ❑Yes ❑No current M N[ r 1 t
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebte79 si4litt 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 1,20 20 20 20 20 20
Signature of County Au s(4 ji.,\.. ��1 dry u Date(m n �da, earl
J\ ,S (J/ r, Q J( r(ii
I/We certify and 1 enalty of perjury that the above and foregoing informs i is true and correct and that the applicant t a r ident of Indiana and
owner/contract buyer of the aforementioned property on date application is fil _
Signature ner's full name))(
Dat ( ea
',Mee* c7r.'9 /4*.eati
Ful��eaddress of app(i t(nvmbe�tr�oily,s�t�and Z!P de) q
f� /1
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 �\\y \ Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imorisonment up to two and a half veers and a fine not to exceed S10.000.