HomeMy WebLinkAboutMortgage_Hofman (2) ate' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count SinioWnship Year
$s'• FOR DEDUCTION FROM ASSESSED VALUATION
/' Prescribed be 4by D pa /6-14)
�-�, Prescribed by Department of Local Government Finance
INSTRUCTIONS: '?le M.j• . ;
To be filed in person or by mail. •. '�• '
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. �I
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is JAN 2 Unty Auditor
located on or before January 5 of the immediately succeeding calendar year. J 4 •i❑G�LJouunty 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 deduction is souf)tJt. •
See reverse side for additional instructions and qualifications. I.Tw•Lt.
Applicant(own`f contract buyer/ie restrictions r verse side) d { 1 GIBSON COUNTY AUDITOR
111`` J1/ 1 -}1• 1
T g istrict It Kr number/legal description Record or ber Page number
dc. -X2 3-1\- aoo -o ■. b i-oa4 � . 2W3
•
value of real property as of ortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March current year March 1,curreryear date of application legal or equitable owner?
a 0 4 I� ❑ 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 ❑ Annualy Assessed
i Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
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 t -• ,•-.••'•'• ction been requested If yes,state amount of deduction
other county 0 "•
in Indiana? ❑Yes 0 N Dr aNN C 1\ ID Yes 0 N
A person is not entitled to this deduction unless 1_40. i�� ..• contract indebtedness that is recorded in the county
recorder's office(including any home equity line \O l .••• %%%% )that is the basis for the deduction.
Cal t
Deduction approved in the amount of:
20 20 20 20 20 20 _ 20
Signature of County Auditor 1 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 aforementi ed property on date application is filed.
Signature(own s full r , e) Date(month,day,year)
/A�/?vi6
'I re • ddr t applicant u rand sire ,city,state,and ZIP code)
Pe 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.