HomeMy WebLinkAboutMortgage_Wilson (8) STATEMENT OF MORTGAGE OR CONTRACT INDEBTED. C Township I Year
rei z FOR DEDUCTION FROM ASSESSED VALUATION � //
k'.� IZI SStatee:orm'3709(R12 IS-Is) ./�i ./
�vv1LL�
\'`� Prescribed by Department of Local Government Finance
INSTRUCTIONS: FEB 2 5 2015 File nark .
To be riled in person or by mail. - •' Form feed with:
•Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deductior is sought
Must be filed or postmarked with the County Audiror or County Recorder of the county yh'1Yre t,a is ❑ County Auditor
located on or before January 5 of the immediately sur-aading calendar year. )•,IPIY/l� ❑ County Recorder
2) Mobile/Manufactured::omesnot assessed as Real Propeny Must tile with UUGIBSQNtC..OUNttie'c®diQITOR
where the property is located during the twelve(12)months before March 31 of each year the deduction(nought.
See reverse side for additional instructions and qualifications.
IApplicant(owner or contract buyer-see reso/odons on reverse side)
^fHtl A . 001 5oul
1 Taring Distil Key number/legal description /n�1e /larder I Recoi nun-er \-I Pare rymo�•
�L ly /8.-26170(5/. l7�—D67 y Ne• �j nI/ [(JO's)
Assessed value of real croeay as of Mortgage/Contact indeo,edness unpaid as of Mortgage/Contact act uAeb,edness unpaid as of Is the applicant tie sole
Marta i,current year March 1,current year date of application
60, OW legal or equitable owner?tit Yes ❑ No
IIfno,whatisrhs/tierexactshareofinerest? If ow ed with someone other than spouse,indicate withwhom
If name on record is different than that of applicant indicate below: Is the property In question:Annually Assessed
(gCReal Property ❑ ArnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of morcagee or contact seller
FT-P41ti, Third I1& K •
Address of mortgagee or contract seller(number and sweet,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
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 puny I I I on property for- ❑No
in Indiana? Dyes .NO current year? ❑Yes
.4 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 orrice(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
I COUNTY AUDITOR '
Deduction approved in the amount of:
20 I 20 I 20 I 20 I 20_ 20_ I 20
Signature of County Auditor I County Date(month,day,yeer)
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.
Signature(owners full name✓A) VJ(/V1 I Date(month,day,year)
`r /Q- ` .f_■
o -.10,1 -I
Full resident address of appicant(number and street city,state,and ZIP cone)
9/1 ti. 1%/n D2)UE• OAK6/3,u/J C, /7/� /Al C 766o
Person authorized by duly executed Power of Attorney or by IC 5-1.1-12-0.7 Date(month,coy,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 tine not to exceed$10,000.