HomeMy WebLinkAboutMortgage_Baker (9) 4a'.; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
'=r�•1 FOR DEDUCTION FROM ASSESSED VALUATION
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'' State Form 4by D par meat �_-
,�, Prescribed by Department of Local Government Finance •
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To be filed in person or by mail. ' filed with:
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 Milfrif21 2015 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must 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 dedu n is so ht.
See reverse side for additional instructions and qualifications.
CIBSON COU TY
Ap nit;(owner or�contmd buy€J-see res' son reverse side)/()/,'/—�/�� AUDITOR
Ta District rw4 r7/` Key number/legal descriptioH Record numb Pegg
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Assessed value of real property as 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?
IS-y cop ❑ 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 Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
— a,ar
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) .
Name of assignee or other owner or holder of mortgage -- - - ---
BA g_ JA/346S - R Te-
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? H /6-J0( —
other county a
in Indiana? ❑Yes ❑No a
A person is not entitled to this deduction unless the person has a balance on the person's r y
recorder's office(including any home equity line of credit that is recorded in the county recc
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(own" full name) rxxixvt • Date(month,day,year)
resident address of applicant( umber and stmet, ,state,and ZIP code)
•
/Sa2 (v , I1o1✓Lrook (Jr. Pr;nceJ-o, 1 PA y`] b7o
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 510,000. 71 V T T -r"