HomeMy WebLinkAboutMortgage_Prior w STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township• Coun Townshi Year
.;{‘;,:sk FOR DEDUCTION FROM ASSESSED VALUATION
:r— tt� Form 4S Pescnbed by Department)of Local Government Finance
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INSTRUCTIONS: ` -
To be filed in person or by mail. Fo filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. OCT 1 '
Must be Wed 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. i •. ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the t'nt 4 :j"
where the property is located during the twelve(12)months before March 31 of each year the deduction -'I.i s7.'"zit
See reverse side for additional instructions and qualifica '- �I/�N COUNTY AUDITOR•
Applican o er contract buyer-see restriction n re e ) E (�
•- strict Key�y r/legal description Record number Pa_gey�rmber
;2 o o -/o?- O�-�O3- Oa3. 9,76,...-oa2do� � 42
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/a) oz y) legal or equitable owner?
/VI�' ❑ 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
Q("�{�'y �/ Real Property ❑ AnnuallyAssessed
C/ (277003/1. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,an ZI code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) O //�u � � //�
at Taxing isirict? Has this ded n been requested If yes,state amount of deduction
othe on property
in In current year? ❑Yes ❑No
Ape ��L(.G(��
A balance on the person's mortgage or contract indebtedness that is recorded in the county
reori S� ��� ecorded in the county recorder's office)that is the basis for the deduction.
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_ \ \ �� a� rl COUNTY AUDITOR .
Deck _, /] m/vJ /'
v l 20 20 20 20
Signature of CountyAuditor 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.
Signatur rs name) Date(month,day,year)
Full resided of)27,)........
p li (number and street,city,state,and ZIP code) •
/70 7 V9/7/40--41. ,%ve ,- - ?—/1/• 97620
Person authorized by'duly executed Power ofAttomey 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. - - -