HomeMy WebLinkAboutMortgage_Beasley (2) rt;n .a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship Year
J t FORe> "T N j;a 12,=1 ., DlC ION 1 ✓� 1}�=• C,'� State Form 43709(R13/10 RECEIVED JO. ` 01 1 cA `.OZO
'� Prescribed by De* a + l GOVe enl Finance
INSTRUCTIONS: S.m )1 1 i� J --3 2M0 File Mark
To be filed in person or by mail. I P F sled 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 properly 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,
Applicant(owner or contract buyer-see restrictions on reverse side)
Nathan Beasley and Brandi Beasley
Taxing District Key number/legal description Record number 1 Page number
Columbia 26-14-19-200-000.888-006 2020 2Z
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicar a sole
assessment date,current year assessment date,current year date o appl)caypn I 1 0t7 lega(ar.eq i able owner?
Il1tS Yes ❑ No
If no,what Is his/her exact share of interest? If owned with omeone oth4 than spouse,Indicate with whom
r
,I
If name on record is different than that of applicant,indicate below. PI-L , Is the property in question:Annually Assessed
0Real Property LiAnnuallyAssessed I
Mobile Notre(IC 6-1.1-7)
Name of mortgagee or contract seller S
Bailey &Wood Financial Group ..b
Address of mortgagee or contract seller(number and street,city,state,and ZiP code) ✓ON rJ
BOO Corpondon Dive,SIe 200 Pendleton,IN A5m4 • 2°20
Name of assignee or other owner or holder of mortgage
•
-
Address of assignee(number and street,city,state,and ZIP code) G/esO�COu
NTYAtft)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction Pep requested If yes,state amount of deduction
other county on-propertyfor
in Indiana? ❑'-y ❑No curnyr? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the persons 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 a20 20 20 20 20 20 20
Signature of CountyA til;ii M c3- JJ :County 1 `O� Date(mot,daynt 0
46
• 1/We certify under the penalty of perjury that ih a and foregoing information is trr a and correct and that the applicant is a resid of Indiana and
owner)contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Dale nth,day, ar)
. O-PQ
Full resident address of appli nu»rbsr and skeet,city,slate,and ZIP code)
11437 E 150 S, Oakland City, IN 47660
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
•
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONT1.•, T D,: TE 1�1€SS
Name of licant ,\,t t 9
. �v l ) f Name ortgagee•d•nt se r
�� I l_ n g
Date filed(month,da,year) Amo t in ebtedn ss Taxing Distri
6. 2 ' 202D. ILiS, Ili-' - UN 3 w^.bt�
Key num r/i I description ^ 20
Grp '-\— I 1 �20 0 —00 g Uy _ oo .
Signature ourditar/County Recorder County �ig month, ay,year)
1 "1 JA9cow., 6. 2. 2020
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