HomeMy WebLinkAboutMortgage_Buck �E`r•TF STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSCounty p
���; Townshi Year
J - e FOR-DEDUCTION-FROM ASSESSED VALUATION
State Form 43709(R13/10-15) GIBBON
rGI6
� Prescribed by Department of Local Government Finance
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 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 yea. ❑ 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. -
Appli n (o�;er tr act b e��y r-fee rgst (iOorr reverse side)
jaV
Taxing District `-AV,,] Key nu\�mbber/legal�Y` ription .� Record number Page number
009- 26-N- --kO2-000 . JZ, -°dam 20 2
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaigLls of Is the applicant a sole
assessment date,curre . ,--rr, assessment date,current year • : date of appl' on ca.:10- iT legal or equi le owner?
f`\JU Yes ❑ No
If no,what is his ap share of.interest? If owned with someon other than souse,indi to with whom -
I a e re . • is differtt i that of pplicant,indicate below: I e property in question:Annually Assessed
1 `," R. • ❑ Real Property CIAnnually.Assessed <
r Mobile Home(IC 6-1.1-7)
Name of morte or contra t , . ° rr ,,
�.'P.' \ Lk _ bfanS\i t 1I� i� o9O O,co .
Address of mortgag e ttr seller(number'and street,city,state,and ZIP code) I CL"- U.
�`� GO �QQePj ��
�. Drawer NO a � '
Name of assignee they owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) Card N O. ca 7 0 7
•
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: ` _ '
OQUNTYAUDITOR .
Deduction approved in the amount of:
20 1 / 20 20 20 20 20
SignaturebfCountyAuditor County . Date(month,d,y y r)
i —NA.„411::‹C-X)-N.
I/We certify under the pena y of perjury that the above and foregoing information is tr e nd correct and that the applicant is a r sid nt of Indiana and
o er/contract buyer of the aforementioned property on date application is filed.
Sig a re(owne s full ame2, ')(
1 k63:je Date(month,, e�r)ti
Full resid t address of ap li nt( umber an street, statOe,and 1P ode) �. �9 6 `
cli
in—
Person authorized by dul ex cuted 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)
Tae a err;ems s...o..,,.,.,-.,..,..,.r,,.4.,im �.n 1...{.-6.........J..I li......-......J..C......-..t b..-...•-..-J PAA fl.,.,