HomeMy WebLinkAboutMortgage_Meny s ,,,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a.,=. FOR DEDUCTION FROM ASSESSED VALUATION
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e Prescribed by Department of Local Government Finance ((�-q,/ 1 )J
INSTRUCTIONS: File Mark
To be filed in person or by mail 1 Z��6 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sa1 ay
Must be filed 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 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Audi:i, d^%��r
where the property is located during the twelve(12)months before March 31 of each y -4 + <r .�(UDITOR
See reverse side for additional instructions and qualifications. �g
Applica(`nntt((oo/wner or contras buyer-see restrictions on reverse side)
T DDiis na L / l Key.1 /legal description Record number Page number
�3�5/J1et�x�J 24—/ 9-/ 9 - /o / - o oo 710 '/ - o a .6 c'OG/b /gift?
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,anent year March 1,current year date of application legal or equitable owner?
iaaa75 ❑ 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 appcant,indicate below:
li I�s theproperty in question:Annually Assessed
f 4al Property ❑ Annualy Assessed
_ _ _ - - - - - -
_ —
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller /
Address of mortgagee or contract seller(number and street,ci , Q a A
® I
purity UUnion .
. Congo Title r r TCie
Name of assignee or other owner or holder of mortgage .
Address of assignee(number and street,city,state,and ZIP cc- r
`r-` r
Does applicant own property in any If yes,what county? ' " yy squested If yes,state amount of deduction
other county ,I,IP
in Indiana? El Yes ❑No 513 r ❑No
A erson is not entitled to this deduction unless the ers, //nn� ndebtedness that is recorded in the coun
recorder's office(including any home equity line of edit W(,i'P ^.- 5),r iI / r 1e basis for the deduction.' ry
Deduction approved in the amount of: )0 I l.fv 0 C 0 v 1 r� e l
zo zo 20_ I __ I <u I zo zo
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.
Sig ure(owners full name) Date th,da,year)
x , A, . r/ -/G .
Fufl r d dress of pri (nu• '-f:nd ree city,state, . . • '
(p A.i1i o 774 441r
Person authorized by duly executed Power of Attomey 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 two and a half years and a fine not to exceed 510,000.