HomeMy WebLinkAboutMortgage_Luttrell }• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
'tf _: FOR DEDUCTION FROM ASSESSED VALUATION
'`'r �0- State Prescribed Department/10.1 —;_T..M
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Prescribed by Department of Local Government Finance
INSTRUCTIONS: i .� ;.t
To be tried in person or by mail
Filing Oates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought 111...LLL
Must be filed or postmarked with the County Auditor or County Recorder of the courtly where the property al 8 Gounty Auditor
boated 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 cou i
where the property is boated during the twelve(12)months before Mandy 31 of each year the deduction is ' 2' t• �•:
See reverse side for additional instructions and qualifications. /'r• NI nidj:;
Applicant(. erorconuad buyer- - . on reverse side) -- thaSONLeett1717-AUDITOR
Key number/legal description Record number Page number
�i I , e9,6e — as _ia _ Soo - nod . 0 `19- oA 'j Aoj a / /0 7
• -t,_.value of real properly as of Mortgage!Contract indebtedness unpaid as of Mortgage r- pa e of application I Contrary indebtedness unpaid as of Is the r applicant the sner
t data,anent year assessment date,current year date of application Iegal or equitable owner?
,3,3 , 7 �� IOL - ❑ yes 0 N
If no,what is his/her exact share of interest? O� If owned with someone other than spouse,indicate with whom
If name on record is different than that of applcant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
. .0
Address of mortgagee or contract seller(number and"beet city,state,.
and ,�..,, I
Name of assignee or other owner or holder of mortgage �n � " �J 1 19
Address of assignee(number and street ally,state,and ZIP code) j i/'\\`(�J
Does applicant own property in any If yes,what county? What Taxing District? Has II /J�/ �2 coon
other county on pit
O` JJJ
in Indiana? ❑Yes 0 N curer
1-9
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/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 re name) Date(liana rei•y,year)
Ful /eTt of appfiant(number and street city,state,and ZIP �� /��
XPerson authorized 0 executed Power ofA co , by IC G7.1-12-04�t4�a j x2639 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$10,000. .