HomeMy WebLinkAboutMortgage_Bailey (15) ,,,...,*. STATEMENT EBTEDNESS County Township Year
11 FOR DEDUC
7. G.�� a" �aae
t\ �� State Form 43709(F O
�` Prescribed by Del D rawer NO File Mark
INSTRUCTIONS: To be filed it as ,_iq Form filed with:
Card N O. !eduction is sought. [Y�nty Auditor
Filing Date: Form must be c Mustv of the county where the property is
located filed or on or bi • ty taxes are first due and payable. CI County Recorder
See reverse side for additional instructions and qualifications.
Aoptcant(owner or contract buyer-see recstrict 1 on reverse side) . I ^�6L I _<
&' r•► • T legal de f t. ' \ ` C Record number Page number
Taxing District • Key number/legal des�npt' ion ( , r ,
��e-1-1-.9 - �I 00-000 -a O O .oa ( . 1aOQD_ "'t
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of legalthe applicant
plica blehe sole
wner?
assessment date,current year assessment date,current year date of application l �
�yt) /1 3 [S� Sp❑No
If no,what is his/her exact share of interest? If owned with someone�other than spouse,indicate with whom
Is the perty in question:Annually Assessed
If name on record is different than that of applicant,indicate below: Real Property ❑Annually Assessed
Pit
Mobile Home(IC 6-1.1-7)
N me of mortga ee or contractsse-lller�� � Et)
Address of mortgagee or contract seller(number and street,city,state,and ZIP codee)) `Name of assignee or other owner or holder of mortgage S`P-62022
r'fe
O~CO
Address of assignee(number and street.city,state,and ZIP code)
What TaxingDistrict? Has this deduction d(g d If yes,state amount of deduction
Does applicant own property,in any I If yes,what county? I on property for
other county ❑Yes t]�'Ivo 1 current year? s No
in Indiana?
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
I 20 I 20 I 20 I 20 I 20 I 20
Count] Date(month,day.year)
Signature,of County Auditor a - <, ` --� C��C �� I Q — `I` D _`ZZ
1,We certify under the penalty of perjury that the above an di
formation is true and correct and that the applicant ist a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. I Damonth(,day,year) �7
•
-
��J� ` 't'�' '
Full resident address of applicant(number and streetR sty,s ate,and ZIP code) �`!- ��� ��
a 0&i3 ... . t O-1 L . `` 1� 1 t--\ti I Date(month,day,year)
Person authorized by duly executed Power of Attorney or b)IC 6-1.1-12-0.7
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.