HomeMy WebLinkAboutMortgage_Reynolds (4) ,....,C-T.);, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
b- ' FOR DEDUCTION FROM ASSESSED VALUATION i I
u State Font 43709(812/6-14) / h
'. Prescribed by Department of Local Government Finance l5I U ' ?iI
INSTRUCTIONS: File Mark
To be filed in person or by mail. DEC 3]1°tl Ot4 wiat
Filing Dates: 1) Real Property: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 immediately succeeding calendar year. - -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property Must rile with the County Auditor of the co 1 , . 7 ,111E where where the property is located during the twelve(12)months before March 31 of each year the deduction is :
See reverse side for additional instructions and qualifications. G I BSON COUNTY AU DITO R
Applicant(owner or cons uyer-see restrictions on reverse side)
ZSosh -<ai Ao. I 0
Ta District 1 Key number I legal descnp'on n m��e++ oe�ion/'��n
V1rin•e-te:∎ 1 Q - /�7 - 67 -ci/ •ee/ d79-OZa ' i `i Cl/JCo
Assessed vale of real payefiy as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1.current year date of application legal or equi• ble owner?
h/1,50. CO ff 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
[t''Real Property ❑ Annually Accessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
The.- 9 e Sew-#e --- ,ay. C cQ la tc in
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
ice Li-le••`* (.tea- r lT rN b')�J t 1 1.,a4`-I R'
Name of assignee or other owner or holder of montagge
Address of assignee(number and street,city,state.end 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 ,--, property for
in Indiana? Yes L-No I current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person nas 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/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 I contract buyer of the aforementioned property on date application is filed.
Signal. (own shdt name) Date(month,day,year)
/2/2 )720/E f
Fu' silent d�of applicant(number and street,city.state,aAZ�IP code)
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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 510,000.