HomeMy WebLinkAboutMortgage_Bell (4) STATEMENT Or' MORTGAGE G.AG OR CONTRACT INU_=1 _1N___ I
County I
Township I year
1te3t7YN FOR DEDUC ION FROM AJJ= JLu VALUATION I EI A J 7ha: S:at=_om e3?C?(31?/that). i/\` Prescribed by Department of Local Government Finance File
Mark
/NS TRUC TIONS:
To be filed in person or by m mail. - MAY 1 12WSed wit.-
Filing Dates: 1) Rea/?ropeny:Must Use completed and dated in the calendar year for which the.deduction is sought.
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the propel proo_a 's ' ❑ County Auditor
before located on or bee January 5 of the immediately s ^din,-calendar year I'- ' WjrTi=l County Recorder
?) Mobile/ManufacturedHomes not assn«°'as Real Prrper'y Must file with Inc County Ruts iskp •r
where the eryisloca at_d during the rwetve(12)months befo t4a,_halo,each year the oucao ! .,MNTi`RbDIIOR
See reverse side for additional ins:rucdons and qualifications.
A^-�idanl(owner or con:, ow -see.resrd-dtns on reverse sire) -
IylCId 4— Mitt 8,PiL
Taxing District; �. b-r/I•^al aes-iddo- rd nunoer Page r._n tar
ir/e7y7a-Eby-Ororcc-6th Pipeis3-.� I aol5 8377
1<ssesed rralue o:real pmr_rry as of Mortgage/Con a_inoeotedness unpaid as of Mortgage/Contact:indeotedness unpaid as of Is the applioan:the sole
Morn 1,a sent yea: I Moron 1,cure.:year pace of application legal or iaole owner?
C2(7`// 9& yes 0 No
I If no,what is his/her exam snare of interest?°25:? (If owned with someone other than spouse,indicate with whom
If name on rear is different than that of applant,indicate oelcvr Is the property in question:Annually Assessed
KReal Property 0 Annually Assessed
• I ��/� /�
/�'�'(�n ' n U� {� Mobile Home(IC 6-t.1-7)
Name Address of mortgagee or contrast seller(numoer and street.dry,stare,and ZIP code)
I'
•
Name of assignee or otter owner or nolder of tongage
Address of assignee(number and street,city,stare,and ZIP code)
IJas ztpficant ow:.property vn any If yes,what county? V'ma:Taxing Dis`iol? Has.this oe:uCJor teen requested If yes,state amount of ^'•-:ion
.er count on P�?e'Y for
calndiaoa?y I Ives f N'o I ourren:year? I_(yes Duo
A person is not entitled to this deduction unless the person has a balance on the person•s mod_th=e 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 recorders office)that is the basis for the deduction.
I COUNTY AUDITOR
Qeourdo n approve'_in the amount of:
20 I 0— I I 20 I 27 I I 20
Signature of County Auditor - Date(month,coy year)
`'u
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.
Signn Cure�owners full ry�e) j 'Dal(month,day,year)
I:evden:a__.__s of acpliwo:(number ant sveeL city s'�ere,and ZIP ape)
Sod. 5 . i sk Sf Otte iisww IIP. IN I/7 W05-
Person authorized oy duly executed Power of Attorney or by IC 5-1.1-12-0.7 rte(month,day,year)
Address of autLri,__person (number and street,city,state,an ZIP code)
The penalties for perjury can include imprisonment up IS two and a half years and a fine not to exceed$10,000. 7 7 7...i it Q