HomeMy WebLinkAboutMortgage_Kelle i v�q STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count I Township Year
,a__ FOR DEDUCTION FROM ASSESSED VALUATION
I
State Farm 43709(R12/6-74) . c I .
,e a' Prescribed by Department of Local Government Finance i
INSTRUCTIONS: File Mark
To be filed in person or by mail. MAR •'i_tr 'th:
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 property i ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. u
2) Mobile/Manufactured Homes not assessed as Real Prope •Must file with the County Auditor oGl@�•y,PU-v,c,11i,r r ecorder
where the property is located during the twelve(12)months bef re March 31 of each year the deduction is sou0ll - •
DI TOR
See reverse ' for additional instructions and qualifications.
Applicant r or contract buyer-see jes:ric4 `/-}oon reverse e) -.0-'7�(�
T 'ng i ,ric 7Key number/legal des tion Record number 1777, r
cv o� -at- -,?oo_ A =DO/ �da is
Assessed value of reeaall�r//�f�/nny��as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current : r {' March 1,current year date of application legal or equitable owner?
❑ 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 th property in question:Annually Assessed
Is
Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller A' ,t �f/J I�/���2 X—k
Address of mortgagee or contract seller m er r s city,state,,and ZIP Qcode)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Oal C$1 �� J-3 -9 X39 ,9e
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 county on property for
in Indiana? Yes No current year?
Ill El ❑
Yes ❑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 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.
\` at a(own ull name) Date(month,day,year)
Q ,
,r Full tgsident addres of applicant(n bef and street,city,state,and ZIP code)
III c-f'g0 5 CPSE O4i1LfninCify -Lt! 9VG0 - PSR4`
Person authorized by duly executed Power of Attorney or by IC 6-1.1112-0.7 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.