HomeMy WebLinkAboutMortgage_Barretto (2) ‹,,Er• , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
a FOR DEDUCTION FROM ASSESSED VALUATION -
%/ State Form 43709(R13/10-15) GIBSON
Prescribed by Department of Local Government Finance I n 011
File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form 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 CountyAuditor 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 revers;side for additional instructions and qualifications.
Appli - t ,�ero ctbUyer-see re 'ction.on�rses��
Ta in.i-trict r /f/Q n er/legal descriptio Record number Page number
6 - a-a1- //- COO. D/ -Q�7 201 kis 26
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
' f
COO E Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than'spouse,' dicate with whom
i
If name on record is different than that of applicant,indicate below: Is t e operty n ct,estion:f fl- Assessed
Real Pro •_. Ill - • al i ,ssed
',..'ei • :(IC6-1.1-7)
Name of mortgagee or contract seller L%J� ' ` �^ Zj( JUL l
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ®�O�O
GCE
Name of assignee or other owner or holder of mort � ���L�G.1'�/�7�f �'� 4 %/� O
o
Address of assignee(number and street,city,state,and I code) 1 roR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? ❑El 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 o o Auditor County Date(month,day,year)
I/We certify i der 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/coin/Ict buy:,r of the aforementioned property on date application is filed.
Signature(o .-.�I. � )
IIL Date(month,day,year)
"1 0. 20 20
•
Full sident ad!ress of applicant(number
and street,t,city,state,,and ZIP code)
°,311 CA) 00J4- I IOv)'-L.J'1 _I1-b9'o .
Person authorized by duly exeduted 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 nenalties for nerhiry can include imnnsnnment tin to twn and a half years and a fine not to exreed. in nnn