HomeMy WebLinkAboutMortgage_Knust (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
(l'= . , FOR DEDUCTION FROM ASSESSED VALUATION {�
'° State Po=43709(R13/10-15) H
�-- Prescribed by Department of Local Government Finance I
File Mark
INSTRUCTIONS: A� ,�t .�u lb be filed in person or by mail
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for whim the deduction is sought .
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ Court Auditor
located on or before January 5 of the immediately succeeding calendar year. I v ,a4,• iii Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th I,1
where the properly is located during the twelve(12)months before March 31 of each year the deduction rse C - -
See reverse side for additional instructions and qualifications.
Applicant(owner r con rasuicdons en verse side)
��D' Kfy number!legal despiptinn Read n r number
i �,-r a[� - ��-aS �(a�-as �2� 50?
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mort gage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
(a no� 1, 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
• cal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
N��joaf mortgagee or contract seller _
- - -
Address of mortgagee or contract seller(number and street -_ . ___�,—_-_-._. .-..-.--- __
Name of assignee or other owner or holder of mortgage I
Drawer NO f
Address of assignee(number and street city,state,and ZIP ^��
Does applicant own properly in any If yes, tW manly? Card NO. �() been requested If yes,state amount of deduction
other in county El Yes 0 N • Yes 0 N
—
A person is not entitled to this deduction unless the pe- . .__._..,,_,_ _. __..cad indebtedness that is recorded in the county
recorder's office(including any home equity line of aedit 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 I contract buyer of the aforementioned property on date application is filed.
Signature( name) / Date(month,day,year) •
i1 44 2
resident address of applicant(number and street city,state,and ZIP e)
Sol . .S- old FVOkA , 2d. . Hrfol�st �N LI-76,$6
Person authorized by duty executed Power of Attorney or by IC 8-11.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street thy state,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.