HomeMy WebLinkAboutMortgage_Barney (4) ,,,c4!•:-11:,,i-14-,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ----County i Town _iYear7
L'Ili- 11, FOR DEDUCTION FROM ASSESSED VALUATION 1 i
State Form 43709(R14/1-2)) Gibsor-1-70*.
2020
•,::‘'...),;,.•:,;:, Prescribed by Department of Local Government Finance _ I
File Mark
INSTRUCTIONS TO be fled in person or by mail.
Ffled
1
Filing Date' Form 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 calendar year in which the property taxes are first due and payable. Eil County Recorder
_ !
See reverse side for additional instructions and qualifications.
T-ii,pp„,„)A rlicant-Cowni. ler or contr-qc!by erisee rn tri ns on eyerse side)
__: _ .._______ ____,,,,,________
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• 2 '-195-`..5-/7- ,S 0 C ---Q kTh i 2.4),Li 1 4,63,9
7Assessed',eine of real °party as of !Mortgage I Contract ir debte-n u d asor 1 Mortgage7Contract indebtedness unpaid as of Is the,applicant Me sole
assessment date.currbei year assessment date current yea- ;date of application lega'or eguitab wrier?
No
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' If rot what is his I her exact share of interest? If owne.d with someone other Man sp.use.indicate with whom
If name onrecod---is different than that of applicant,indicate bele, Is the pr _ yin question:Annually Assessed
E eal Property [11 Annually Assessed
! , Mobile Home(IC 6-1.1-7)
_____. _ _.„. _.._.............. _____
N me of mortgagee or contract seller
r--Address of risortgatzee or contract seller(number and street.city sta(e.and ZIP code) - kiLy 0a,..1 ,4. __..........._
____ . .__...........„._
f-,,,,i.;,-,. or assignee or other ovmer or holder of mortgage 1 ,,8, __
__ _____...._.......
r:4(::,d-r e 5 0 f'-';;T:6J(number and s(reet,cty.state and ZIP cede)
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Does applicant own property in any . es what county? ---rAlhatfaXTeg District? i Ha_ • - _ 1
]other,county r...--, 1 on property for ,--,Yes
I
!in In ri ciaa? Licl Yes 1-0
— ' ..1. _ .current year? Li L1 No 1
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.
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COUNTY AUDITOR
DeduetOh---approved in the amount of
20 20
1 20 i20 20 I 20 i 20
- 1
L , I iii ,)
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]Sign ur ate of County Auditor 1.,„ ,,.., County Date(month.day ea
,--
c>., ./
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i i VVe certify under the penalty of perjury that the ve and foregoing information is true and correct and that the applicant is a resident b nd na a-2--
owner/contract buyer of the aforementioned prope y on date application is filed.
C•11
7.\,....
! nature tovvres, full name)
•_AA.Z.-eididli_ 1 Date(month day year -.,,, CIO •1 >-
„......,..
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' Fu!,res,-lent address of obeli- ((number and stre4t city state and ZIP code.) ----------- CD =
Z1,/39 W. _5g (...‘,3- kelLic),k.6i___ 0
ll'ersonactliiorized,by duty executed Pose-of Attorney or by IC 6-1.1.12.0 7 —— ----------- bate(month.day yea.) al 2
a
Address of authorized person (number and street.city state.and ZIVcode.)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10.000.