HomeMy WebLinkAboutMortgage_Hale (13) it, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION -gYY�8
� �'• State Form 4by D p r Department ��
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. � `L t{�� 6 20 5 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the dec . orZis sought.
Must be filed or postmarked with the County Auditor or County Recorder of the codo y where the p Vii.-try is County Auditor
located on or before January 5 of the immediately succeeding calendar year. A -al Oft ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Co �t.t j'f. my
•where the property is located during the twelve(12)months before March 31 of each ••V' :*$7Eracti.n is sought.
See reverse side for additional instructions and qualifications. Grl G
Applicant((oo tier wcontract/b{'er-sere./resWctionsj9r aeersee0sidee)) GO—
T istrict 'Key number/legal description Recorg number Page number
tem
24-ia —is--1o / co / a7oaf 015 ift
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant sole
March 1,anent year March 1,current year date of application legal or equitable owner?
n7(f 600 ❑ 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
e. tfiteal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee ocontract tier
Address of mortgagee or contract seller(number and
Name of assignee or other owner or holder of mortgat Draw•e t- NO.. v7
Address of assignee(number and street,city,state,a, �J
Card NO. C" / /
Does applicant own property in any If yes,what coi -- Dn been requested If yes,state amount of deduction
other county - .
in Indiana? ❑Yes ❑No ❑Yes ❑No
A person is not entitled to this deduction unless :ontract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded In the county reamer s uun;o)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 I We certify under the penalty • perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contra buyer of the .'•rementioned property on date application is filed.
Signature(o s full name . , Date(month,day,year)
Full re i dress of applicant(number and treet,treet,city,sta e,and ZIP cod 9)
90 5 5 Ufa// aS-/Ke e 7
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.