HomeMy WebLinkAboutMortgage_Greubel •E STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-5 County Township Year
b FOR DEDUCTION FROM ASSESSED VALUATION
Sit/ State Form 4by 9(R12 6-14) F g T
•� Prescribed by Department of Local Government Finance 1 3,� '
INSTRUCTIONS:
To be filed in person or by mail. JUN r J Form f�p,4lwth.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. L U J
Must be fled 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 year.
. -gecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coup
where the property is located during the twelve(12)months before March 31 of each year the deductg) Nhe 0 UNTY AUDITOR
See reverse side or additional instructions and qua!' ations.
Applicant(own or ntract b�uyer--see restric s on e e side)
xi . rnstnct Key Ar/legal description Record number Page num r
�istrict J' -/a-/s-400 -000. 7o 02- U; '2 Ago* X77
Assessed value of real p as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current March 1,current year date of application ,�r�,✓.�l legal or equitable owner?
/4 ❑ Yes ❑ 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 the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ���'L}5
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage `�j / r i-1
�`T (/ICJ, Y f/C /5;0.2 —76 //
Address of assignee(number and street,city,state,and ZIP code)
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? ❑
DI 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 of County Auditor County Date(month,day,year)
I I We certify under 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/contract buyer of the aforementioned property on date application is Filed.
Signe wnels full name) — Date(month,day,year)
tFull resident address of apg ar-
, (number and stre city state,and ZIPZe) 170
3/98 C&4'*ce :L efaY1- b
Person authorized by duly executed 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 penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.