HomeMy WebLinkAboutMortgage_Sablone h, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count n Year
Si, FOR DEDUCTION FROM ASSESSED VALUATION
y 'd State Prescribed by D Department �
�� Presaibetl by Department of Local Government Finance JJYLL g eC
INSTRUCTIONS: OCT 1 O'�j 6++rt
To be filed in person or by mail Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the prope is ty Auditor
located on or before January 5 of the immediately succeeding calendar year. CounttytRecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditors.f thgprpycw1IN�. AUDITOfZ
where the property is located during the twelve(12)months before March 31 of each year the dde716b HthN{�1s3's'&gM.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Roger F Sablone
Taxing District Key number/legal description Re OW/. Page pa (
Patoka 26-12-06-104-000.605-028 Vl �—r(
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,cement year March 1,current year date of application legal or equitable owner?
185,000.00 0 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 contract seller
Mortgage Research Center
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1400 Veterans United Drive Columbia, MO 65203
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes IN No current year? ❑Yes 12 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
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.
Si tore till name Date( tit//,day.year)
' D—t//7
Full reside tswt?'ess of applicant(number and street.city,state,and ZIP code)
1208 North Main Street, Princeton, IN 47670
Person authorized by duly executed 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 Iwo and a hall years and a fine not to exceed$10,000.