HomeMy WebLinkAboutMortgage_Hunt (2) s' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
Stare Prescribed by Department of g
Prescribed by Department of Local Government Finance °py}'q'1� ,
INSTRUCTIONS:
To be filed in person or by mail. o ,,��LL��th:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought- JUL I]
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. C 81ty-Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coon I
ere the property is located during the twelve(12)months before March 31 of each year the deductim COUNTY AUDITOR
See reverse si<- or additional instructions and qualifications.
Applies t(off o Jr dentract buyer-se s on rev; side)
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ct9 Key number/legal descrip' Record number Page m r
. . d do ,AO (191,07/9-611/ g0/Y .1
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,wrrent year date of application legal or equitable owner?
9'‘
fa) ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone o er than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Asr.Psced
Ale Real Property ❑ Annually Assessed
Name of mortgagee or contact seller Mobile Home(IC 61.1-T)/y /1
• / .14 02.0
Address of mortgagee or contract seller(numbe ajkt,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
a /7 Address of assignee(number and street,city,state,and ZIP code) 0, /v J rJ ����/Q Has this deduction been requested✓�1�e /t' e ircbdr /
Does applicant own property in any If yes,what wunM_ _I What Taxing District? Has this deduction been requested If yes,state amours of d
other county on property for
in Indiana? ❑Yes ❑No J - n_❑Yes ❑No
A person is not entitled to this deduction unless ti �' Wl� mtract indebtedness that is recorded in the county
recorder's office(including any home equity line• .[]1.811' •C I' 1NO /\' tJ that is the basis for the deduction.
Deduction approved in the amount of: 4l
Card NO. ..... 9 7 J
1.1.......
20 20 20 20
Signature AY Auditor {/�7--M 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.
re wners full nnaamey . v (,, / Date(month,day,year)
Fh entd aadF —dfopPlwaannt/((num/76e.rrraa/•street,d state,an. • .•.•e)
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1( .. i ' i. %/ /
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e •n -u1 orzed by duly ezecued P•w_o A me o by I_6-1
-1 -0. 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. -