HomeMy WebLinkAboutMortgage_Morrison (5) sn STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
lzse .-; FOR DEDUCTION FROM ASSESSED VALUATION
*3 State Prescribed by D(R12 Department F I
i•�' Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. C D 1 C c Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deductigE'Fsa/gr7t.20�J
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. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cou .jni,'•-iyA11y t.unty 2
where the properly is located during the twelve(12)months before March 31 of&lily& -:• •NTY AUDITOR ht.
See reverse side for additional instructions and qualifications. Ili;I BB JJUU
Applicant(owner or contract buyer-see restrictions on reverse side)
g Distil umbe al description Record number Page number
TOP abr LA— t5'` tao - octelag— da-] ac1S 39 /
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 March 1,current year date of application legal or equitable owner?
t bo 003 r'es 111 No
If no,what is his/her exact share of interest? J If owned with someone other than spouse,indicate with whom t
If name on record is different than that of applicant,indicate below: ?eel�the property in question:Annually Assessed
' teal Property ID Annually Assessed
ll Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller•
T r L.Q
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage •r--�'
Address of assignee(number and street,nit};state,and ZIP code)
(/� 7,
Drawer NO
Does county
applicant own property in any If yes,what county? What Taxing District? ��� / ction
other aopnty
in Indiana? ❑Yes
A person is not entitled to t 's deduction unless the person has a balance on the pet Card \i O. county
recorder's office(including any home equity line of credit that is recorded in the county sewsucr a uun,ur u,uc.a u,o ueara rut ure ueaucuura.
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/contract buyer of the aforementioned property on date application is filed.
Cdetweeds full name)' / // Date(month,day,year)
address of applicant(number and street,aty,a and ZIP code)
°�zg7g 67,19p �-fai >"rrrnrltO4 � �76 7o
Person authorized by duty a cute Power of Attorney or by IC 61.1-12-0.7 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.