HomeMy WebLinkAboutMortgage_Motter t^• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION -
" Stave Forth 43709(R12/614)
,�„ Prescribed by Department of Local Government Finance I i�
INSTRUCTIONS: ( llr' 'J ,i
To be filed in person or by mail. Form sled wi' :
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. �-n
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is APR 216. govgty 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 County Auditor of the coun�
where the property is located during the twelve(12)months before March 31 of each year the deduc' is so
SAep�we(o side for o• tracttuyeerr-seem wk;jop revqualifications.
rse side) BSON COII(y7y AVU1TOR
07TC/C� / f� At G(1
Taxi • •istri• Key n bet/legal description Record number Page ember
a . •i 7-03- `ice - DO/ /073- 002-7 aq0/6 ��o
Ass value•. 1•roper I Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
a - I March 1,current year date of application/� / ,r n 00 legal or equitable owner?
l 7 6, al of• ❑ 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 e property in question:Annually Assessed
�j Real Property ❑
Mobile
n \ n Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller y // r Q� n
•
Address of mortgagee or contract seller(number and et,city,state,and ZI code) 37/i,a
Name of assignee or other owner or holder of mortgage / / )
Address of assignee(number and street,city,state,and ZIP code) f`//�
Does applicant own property in any I If yes,what county? I What Taxing District? Has this deduction been requested l It yes,state amount of deduction
other county _. -- --- on property for
in Indiana?��veC—n current year? ❑yes ❑No
A person is \ `n l •on the person's mortgage or contract indebtedness that is recorded in the county
recorder's. Q\(:\koz(d1 (Th P th I^1SQ, in the county recorder's office)that is the basis for the deduction.
1 UNTY AUDITOR .
Deduction a, L .�01-i-a .(- 'Vc� \�'�' J(�ria�,44c
zo- 14 , w� 20 (n Z O ) 20 20 20
Signature of Ni `3 Lv3 ,(� _ J
1 t r'_\ County Date(month,day,year)
I/We ce_.,._.._.,..„,o penairy 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.
Signature(owner's hull name) Date(month,day,year)
)C la rn�
Full rey ent address of applicant(number and street,city,state,and ZIP code)
7s 5351DS it T l 1.D Q es\Su\ Ile /Z A) L/ 766 S
Person authorized by duly executed Power or 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 510,000.