HomeMy WebLinkAboutMortgage_Greenwell (2) t R. STATEMENT OF MORTGAGE OR CONTRA EiTE S County Township Year
FOR DEDUCTION FROM ASSESSED VALU AA 9-/
State Forth 43709(R12/6-14);-„ Prescribed by Department of Local Government Finance . 25315
INSTRUCTIONS: �U`' 1 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for w r h'-.i r;.jp r is sou t.
Must be filed or postmarked with the County Auditor or County Reco •. 1., - 4••• Allied'8oropetty is County Auditor
located on or before January 5 of the immediately succeeding a &rO ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property: file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Aeolic/lit(owner or corityct buy see restrictions on reve e side)
T- 'ngiiptrict Key number/legal description Record number Page number
o Tr a -.J-rn-pa' dog. aa3-ok7 ,20 is a-8z 7
Assessed value of real property of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,Current year date of application legal or equitable owner?
/60 000 ❑ 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 belay:
.1 to 11-7)
Name of mortga gee ror contract seller Ls�'77Qm 1
o
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Ca rd[Jf ..'...... (��,�._//�///.��+��1'
Name of assignee or other owner or holder of mortgage .fi, I wO•
"T /
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 county on property for
in Indiana? Yes ❑No current year? ❑
❑ Yes ❑No
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)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.
Signature(o Les%Iican (n'e) / Date(month,day,year)
// 7/10/it
Full re ' addr tier and et,city,state,and ZIP code)
Pe -authorized by duty executed Power of Attomey 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$10,000.