HomeMy WebLinkAboutMortgage_Roos ,,^•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:%r - li FOR DEDUCTION FROM ASSESSED VALUATION
=;` State 43709 /614)
.‘tr, Prescribe d by Depa rtment of Local Government Finance FILE
File Mark
INSTRUCTIONS:
To be filed in person or by mail. JUL 3i. fin 15h:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coup
where the property is located during the twelve(12)months before March 31 of each year the deductic21 f8$@Jyt000 I Y AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or tract buyer,-f see+If�frictions on reverse side)
M.4 f,7— .1=1 .
T • g D' rict ey tuber/legal description Record number Page number
a& g- 3/0- ,3 - t�c� S19 - Oa rib 5
value of real property as of rtgage/Contract indebtedness unpaid as of Mortgage/Contract indebt ness unpaid as of Is the applicant the sole
,current year March 1,current year date of application legal r equitable owner?
at 1 Cc 3 Yes 0 N
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: I the property in question:Annually Assessed
[Real Property ❑ Annually Assessed
_ Mobile Home(IC 6-1.1-7)
Na a of mortgagee or contact seller
Ad ress of mortga or contract seller(number and street,city,state,and ZIP code)
DU s, JPmes
Name of assignee or other owner or holder of mortgage �/1- J
Address of assignee(number and street,city,state,and ZIP cote) �0/S— f�
Does applicant own property in any If yes,what county? What Taxing District?
PA ad,—F C u,Z/�ij won
other county / .
in Indiana? ❑Yes ��,,// /
A person is not entitled to s deduction unless the person has a balance on the pe 1-72-7 1t Nit to county
recorder's office(including any home equity line of credit that is recorded in the cot �-j--
COUNTY At t/D�/9 b03
Deduction approved in the amount of: /7 / W
20 20 20 20 - f0
Signature of County Auditor w.....,
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resiu ,,._I Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
S�Qignatur owners full name) n Date(month,day,year)
Full r ident address of applicant(number and stre ,city,state,and ZIP co , ,,1
'%P/ VICS(f c4 c�4,1 (Al ry I4 k1 z 'C2Ct3
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 S10,000.