HomeMy WebLinkAboutMortgage_Dupps (5) an STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION v
Presorted rte by par/10-15) p ,
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Presafied by Department of Local Government Finance J®U
INSTRUCTIONS: File Mark
To be filed in person or by mail. AU L. Fp�file6w(th:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought v L��u�I UU
Must be filed or postmarked with the County Auditor or Courtly Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. // E),.Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the count' OIP/L
where the property is located duri • •• ; twelve(12)months before March 31 of each year the dedu jtf.COUNTY AUDITOR
See reverse sid: for additional
Record number Page num
( '��/I � -1 ./ergo/Oda .SOS-aa 7 G?Q/ 0399Y
Assessed value of ppely as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment da s,dduurtrteerrdd sarr assessment date,current year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than wise,e�xate with whom
If name on record is different than that of applicant indicate below. Is the[ property in question:Annually Assessed
eat Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .
Address of mortgagee or contact seller(number aloe sbee4 city sta e,and code) ///
Name of assignee or other owner or holder of mortgage n ,7 ,,/n/
Address of assignee(number and street city,state,end ZIP code) // r L2 /� /2
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes, a amoun of deduction
other county , property for
in Indiana? Yes ❑No =rent 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 --•- --a•••cro nr.vwlit.that is recorded in the county recorder's office)that is the basis for the deduction.
Ye-vAY\SL �_ COUNTY AUDITOR
Deduction R a� A • O�ee i ou3
20- 3 0 I 1 l q . 20 20 20 20
Signature a D ((. - Y 1 q O --i'... - (a County • Date(month,day,year):
I/We certify under the penalty of perjury that me aoove am,wregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the/aforementioned Rropertyondateeaapplication is filed.
I�S� \! 4'C a fl Date(month,day,yam
c 41 P(L
Fug resident address ol app' t(number}g city,sta •a ZIP code)
g( YN Poi !K V f ✓P 0,4_g/fs.ieZ-- /t 1 wJ `(1C o
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 sheet 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. _ .