HomeMy WebLinkAboutMortgage_Baughn Jr . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
; f,ri FOR DEDUCTION FROM ASSESSED VAL,UATION 1
, ';r State Form 43709 R13 I 10-15) ( P
' d' Prescribed by Department of Local
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.
App1i rX caner or contract buye3see re tr ns on revels side)
T D-trict Key number/egal ription Record nurrftr P ge mber
2014
Assekdd value A real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtednes unpaid as of Is the applica the sole
assessmentdate,current year assessment date,current year date of application legal or equ,i le owner?
I J S\O� • Yes El No
If no.what is his I her exact share of interest? If owned with som ne other an spouse,indicate with whom
If name on record is differentthan that of applicant,indicate below: I� Is the operty in question:Annually Assessed
eat Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller DEC3y ta n . 1 0 2019
Address of mortgagee or contract seller(number and street,city,state,,aand 1 ZIP de), -
GIBS ;�v
Name of assignee or other owner or holder of mortgage ON COUNTY,q U r)t-r p .
Address of assignee(number and street,city,state,and ZIP code) It D / 9 _- 4 O - -
Does applicant own property in any If yes,what county? What Taxir Drawer NO If yes,state amount of deduction
other county
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balani Card NO, ss that is recorded in the county
recorder's office(including any home equity line of credit that is records - • r the deduction.
C
Deduction approved in the amount of.
20 I , 20 20 20 - 20 ' 20• 20
Signature o !oil,‘Audit rTi n (Ems) County • Date(month, �yryea IC1
I/We certify under'the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a residen of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
St! ature(owner's full name) Date(Mkt/Neap g
F.(resident addr of ice ( mber d street c ,state,and ZIP od
�s i� co k�iTe_ — L 1 -6 i
Person authorized by duly execute P,wer 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 year's and a fine not to exceed$10,000.