HomeMy WebLinkAboutMortgage_Hormuth sr.', STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' + - FOR DEDUCTION FROM ASSESSED VALUATION
'j_.'�[a I: State Prescribed by Dee 2 meat F
..'"<:,-- ' Prescribed by Department of Local Government Finance LE
INSTRUCTIONS:
To be filed in person or by mail. ,h:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. JUL , Mr'
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is iu County Auditor
located on or before January 5 of the immediately succeeding calendar year. . /1 v�/.- • -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAuditor of the cou ', , rs�l;mlgr
where the property is located during the twelve(12)months before March 31 of each year the deduct: jot{ OUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or b strnctions on reverse side)
N
Taxing District ey;"mbar/legal description Record n.'er Page number
)- ID -3t0 3o -t04, as/1 -oa► i. a5a8
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,current year Mardi 1,Current year date p uon legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone tha�se,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 Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller '�^J/'F'�,/��' ^
Address of mortgagee or contract seller(number and street,city,state,an code) ����k%�JCI ' "JT�M'
Name of assignee or other owner or holder of mortgage V •
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county —.. -- •---'sted If yes,state amount of deduction
other county
in Indiana? ❑Yes ❑No Jt h} , ) 064)41M44—+A. i No
A person is not entitled to this deduction unless the _v�`'�r�.CaJ - tbtedness that is recorded in the county
recorder's office(including any home equity line of basis for the deduction.
dv/5—d5dg
Deduction approved in the amount of.
20 20 20 20
Signature of County Auditor 'County - Date(month,day,year)
I/We certify under the penalty of perjury the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer dr d property on dat e application is filed.Signature( W me Date(month,day,yeah o pli and street,city,state,/ha/n`nd�/ IP code) . _
Person auth�edby duly executed Power o�rney or by IC 6-1.1-12-0.7 41 6( 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. - - -