HomeMy WebLinkAboutMortgage_Loyd nry, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i s FOR DEDUCTION FROM ASSESSED VALUATION
y_ l. State Form bed by D Department }' I l
'„; Prescribed by Department of Local Government Finance ED
INSTRUCTIONS:
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 which the deduction is sougn4U L 2 0 20
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. . ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the CountyAuddor o countu `l
where the property is located during the twelve(12)months before March 31 of each year the dedu
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
Applicartgner or contract buyer-see restridiins on rev rse side)
Taxing Distriaa" Key number/legal de Record number Page number
luk.t./..., 2-6 - cis -i ' _ 031 - 000. 309 _ o/8 ,to/S- 2 ,5-//
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1.current year date of application (/��o legal or equitable owner?
. 7 /, 0 0 ❑ 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
❑ Real Property ❑ Annually Accecsed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller A
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Adftess of assignee(number and street city,state,and ZIP code)
YT M D 34 - 1 - / D • LLSs- c.
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 mortgag -"^^ness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's ''1 -'-
COUNTY AUDITOR . Of R})C( NO .(�V./„„
Deduction approved in the amount of: (�
Card tNO. ... /�
20 20 20 20 2' _
Signature Auditor County
-A
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.
Sig e(owner's full name)
Date(month,day,year)
r
,.Fu e t address of ap�n_t(nu ands t city,stat and ZIP code) r� c\ '^_ —(— t�
(t`y I 3 rvi`\�f Jf� ��\ gyp( G 7 cO ii, C
Person authorized by duly 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 S10,000.