HomeMy WebLinkAboutMortgage_Bartley (2) .0. ♦r% STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
141 A. Oi\ 0Q b FOR DEDUCTION FROM ASSESSED VALUATION rr
',,.
" J`• L'i� State Form 43709(R14/1-20) '.7407/v
--%•' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. I County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ ounty Recorder
See reverse side for additional instructions and qualifications.
Applicant w er or co a buyer-see res 'ctions on reverse side) i .i i, or
v..
I _
Ta . Di ric l • n er description Record number Pag number
l,ritA' Vg a.43 -!d0-o04. i-d prOAO le/0 �///�
ssessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sile
assessment date,current year assessment date,current year date of applica' n legal or eq ble owner?
COO es ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is t property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sell
fil pit . .
Address of mortgagee or contract se ler(numb' r and stre t,city,state,and ZIP code)
Name of assignee or othet2lder of rtga e // �/ asp
o o�Cv 7l�.. 11 0 01- DEC �Q •
Address of assignee(number and tr et,ci ,state,and ZIP code) V " 2020
Does applicant own property in any If yes,what county? What Taxing District? Has this d,other county on properf „��v — 6 / Q r
in Indiana? Ill Yes ❑No current ye, /mil
A person is not entitled to this deduction unless the person has a balance on the person's mortgac J`/j
recorder's office(including any home equity line of credit that is recorded in the county recorder's, Drawer NO _
COUNTY AUDITOR _
Deduction approved in the amount of:
Card NO.
20 20 20 20 20
Signature••/,. nty,euditor/�� County I Date(month,day,year)
41
I W certify e th penalty of pehat the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the afore n' ned pr rty on ate application is filed.
Signature(o r' 11 n e) Date(month,day,year)
X / / z /ez7
Full res' t a es jpli nt( beran ree, e,an Z c d �`�Oor
P r n authorized by duly executed Power of Attorney or by IC 6-1. -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.