HomeMy WebLinkAboutMortgage_Poskin , . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
fiv:< FOR DEDUCTION FROM ASSESSED VALUATION
' '° State a 43709(R13/10.15)• Presadted by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mait nn filed with:
Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought JUL
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is cosunty Auditor
located on or before January 5 of the immediately succeeding calendar year. A dun' c-corder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coil r ,r ilia where the property is located during the by lve(12)months before Mardi 31 of each year the reducer y" O N =:
See reverse side for additional instructions and qualifications. u'6SO COUNTY AUDITOR
App&a wneror contract buyer-see'res/trrkkneons_on-everse_side) p
Taxing District Key number/legal description Record number Page number
a10 � 10 - 310 - lot - coo. a63 - b ,_/ a.0 ( (o /9 . ?-
Assessed value real property of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment dab',anent year assessment date,current year date of application I legal or equitable owner?
L I TI a,s o ❑ 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 the property in question:Annually Assessed
0 Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .
I
Address of mortgagee or contract seller(number and street city state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,sta ,and ZIP code) ,—
v
/1 / /lea-- — _ _
Does applicant own property in any If yes,what county? What Taxing Has this dedudx
other county on property for - ' '
in Indiana? ❑Yes ❑No cement year? l
A person is not entitled to this deduction unless ore person has a balance on the person's mortgage or r Drawer N O.... y/„(,r
recorder's office(including any home equity line of credit that is recorded in the county recorder's office;
COUNTY AUDITOR r •
l L( � '"1
Deduction approved in the amount of C a r(1 'N O. Or- .
20 20 20 20 20 20_ 20
1 Signature of County Auditor County • Date(mwitk 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 I contract buyer of the aforementioned property on date application is filed.
signature 7 ante) Date(month,day,year)
)(akin resident address of appecant(number and street city,Mate,and ZIP code)
66oS w yoo S pu& o;Or, = lu 4/7661- -9/3/
Person authorized by duly executed Power of 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$10,000. .