HomeMy WebLinkAboutMortgage_Bent ��cal STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count'' I Townshi Year
° FOR DEDUCTION FROM ASSESSED VALUATION F'iii I .
Slate Form a3TOD Department a)
% T" Pnesaibed by Department of Local Government Finance
Flli a Mark
INSTRUCTIONS: MAR 'gn�4b
To be filed in person or bymeet.
Filing Oates: 7) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the CountyAUdtor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ..,, a -r;• ocgydcr
2) Mobile/Manufactured Homes not assessed as Rea)Property:Must file with the County Author of the fI nude,
where the properly is located during the twelve(12)months before March 31 of each year the deducSlB$ tCd YAUDITOR
See reverse side for eddtional instructions and quakbcatrons.
La ;miner. a b yen-see real son verse sde) �
?Jill 1n1L INrn 14.f. n �!
Taxing Dissitl Key number 1egatdesai P+- E I -3- 10 h,•- P . -•Qr'^
�y� rpm ToWnl`>Q I26-IQ-1 ,, "��-�.• . i W
1M siY1.l a-�Cotac indebtedness (_.7_ _
Assessed value yes, popery ot Mortgage/Cefit yea iitleNeddess umpa�d ash MMgagel Cararad irldeblodrless=paid riot Is legal applicant a the wner of
Math 1,Ong year ttarlt 1.'refit year da' d aPPl.�eon leper or aPa'able owner?
4 &Si3l03,31 ❑ Yes ❑ NO
II no vital Is his t her exact share of auYreSt7 If owned*tut someone other than spouse.indicate Meet wham
U name on record is daherent than that of app cart indicate maw Is die property in wresnorr Airway Assessed
❑ Reef ProPeny ❑ lyPssessed
Home 6-1.1-7)
flame ean idK�± t l r�1 - ahcl V ihahe.ebl/he.
A h_o 7T AI& t(lA! zr e�.
crt start. ti E_:,.i\11 3'1
Name ofass:gnee or other owner or trader d tcrtgage ' 14 r
Ada:[SS at assignee(number and sweet,cry,Sala,end ZIP code)
Does axlkam own prapcny in any (U yes,what comely? t%tat Taxing Distdt Has Ups demean been requested n yes,ste amount of deduction
n� ❑Yes ❑No 4 current yew? I-1
in 0 N
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)Mel is the basis for the deduction.
• COUNTY AUDITOR
-bedidiwi approved In the amaad of:
20 20 20 20 20 20_ I 20_
Signature al Casey Auditor County Date fan-rh.day.Pun
i PA/8 ceNty under the penalty of perjury that the above and foregoing information is true and cones and that the applicant is a resident of Indiana and
i
owner l=tact . er of'Ks aforemerdgned property on date epplxation is Lied.
Signature, e IDrem�ala e°
Fun rest,/ address al appeeM(rev er and city,tram, ZIP code)
•9 E.5`.55i cfl arch IN 4948
Person authorized by duly executed P&xer of Attorney or by IC 8.1.1-12]-0.7 Date(nandi.day,year)
Address of authorized person (number and 52e,cry,state,end ZIP=lei
The penalties for penury can include impdsormuent up to two and a had years and a fine not to exceed S/0.000.