HomeMy WebLinkAboutMortgage_Wildt .c.N STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year 4.
i.NZ I FOR DEDUCTION FROM ASSESSED VALUATION
�N J 'F State Forth 43709(R12/674) I L, F4 1
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. JUN G`8n7E46"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 is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. �1ntyFrecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coup (
where the property is local during the twelve(12)months before March 31 of each year the deductealeignitOUNTY AUDITOR
See reverse side for additional instructions a d qualifications.
Applin er or contract buyer-se stdctio son n3ve/fe pjde)
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Taws• Key u berl legal descri tan Record number Pa 9,e n ber
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value of real p as of /Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year // ` , March 1,current year date of application U legal or equitable owner?
('-h7Jj 0V UA ❑ 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 a property in question:Annually Assessed
Real Property ❑ Annually Assessed
// `` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller •
an
Address of mortgagee or contract seller(number and sues ci state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,d71 state,end ZIP code) P� >On Y f /‘ o2—70. / 7�
Does applicant own property in any If yes,what county? What Taxing District? Has this been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? ❑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 appro \ \ 1 1---5 _
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20 20 20 20
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Signature of Co �� ""o•+v�, `�-a0�0 County Date(month,day,year)
5 ? 1 \Ln • a4 s-ac- IL
I/We certify -der the penalty u,p...,_., . hformation is true and correct and that the applicant is a resident of Indiana and
owner/con act buyer of the aforementioned • •- app.......an is filed.
Signature(ow er's full name) / , Date(month,day,year)
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u - id nt address of app i+ n r and st : 1..city,state,and ZIP code)
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Pe • authorized by duly executed PpSver o A omby 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. - - - . - --