HomeMy WebLinkAboutMortgage_Hoke /!fir. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi• Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 4310g(R12/6-14)\ I Prescribed by Department d
Lod Government Finance ��
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INSTRUCTIONS: - !I:
To be Ned in person orby mat ' :111, ;rprl, -
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for with the deduction Is sough County Auditor
Must be lied ofposfmarked with the CountyAudtor or County Recorder dthe county where the pm s O0 County Recorder udit
lolled on or before January 5 of the immediately succeeding calendar year. H U lT 5
2) Mobae/Manufactured Homes not assessed as Real Propeey Must Isle with the County Auitorof the county
wherethenal instructions is boated duuatifietwelve(12)months behue Mardr 3f death year lie deduc' b7yq
See reverse side(or eddtianal Mswd(ons and qualifications. uIWI —�
' arise` .1-t e ancltiisP°y Mew site) GIBBON CO,NTY A
spl DIT o'.
�RH°�wnship aahhber2 55e -000.883-027 - i�..••A
Assessed rake cheat property as a MMg De/Contract indebtedness u paid as of Mortgage I Cruet indebtedness unpaid as d Is �( the etgatable Match t,0. .00 MaCt 22 9081.00 ii Yes ❑ No
II no.what Is his I her exact share at:detest? It awed was someone other than spouse.Indicate wf71 wham
gnome on renad is actin than that at applicant,indicate below.. is the propety In question:Ann ally Assessed
❑ Real Pfopeny ❑ An.nuatly
Hand /.,-n
NagatW or r tpgenagtae d Company
Address of mortgagee or contrast seller(number and street,city.state,and ZIP code)
5001 Kingsley Drive, MD: 1MOCBQ,Cincinnati,OH 45227
Name of assignee or other owner or bolder of mortgage
Adams of assignee(number end street dry,gate,end ZIP code)
Does appal own property In any -U yes what county? Mal Taring Dimid? Has sus deauctbn been requested If yes,state amount of deduction
other m la
❑
in Indiana? Yes 0 as year? Yes 0 No
A person is not enbded to Mis deduction unless the person has a balance on the person's mortgage or contract indebtedness that Is recorded in the county
recorder's office(alluding any home equity line of creel/that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Dedudton approved In the amount ot
II
20 20 20__ 20 20 20__ 20
Signalers of Canty Auditor County Date(mdrd/s,day.seed
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.
yaLres�a�ehG�1 .,�1 �0 M,l IQ) --0- .0 D-( 31/2019
F 221 Lake nor d ( end meet a sure,and Zr )
00o Drive, Princeton, IN 4670
Peron authorized by day nosed Paver or Attorney or by IC 8.1.1.124.7 Date(nnnN,dey,peen
Address of audruized person (number and street city.:rate,end ZIP code)
The penalties for perjury can include imprisonment up to two and a had years and a fine not to exceed 510,000.