HomeMy WebLinkAboutMortgage_Lutz „ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
.i\`- FOR DEDUCTION FROM ASSESSED VALUATION IIIM
I'° State Fam143yD(R13f 10.15)
Presrnbed by Department of Local Government Finance
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INSTRUCTIONS:
Tb be filed in person or by mail. Form also with:
Ring Dates: 1) Real Popery Must be completed and dated in the calendar year for which the deduction is sought Q UG 2 2 y(}��
Must be filed orposbnarked with the County Auditor or County Recorder of the county whom the property is 'l!Y County Auditor
located on or before January 5 of the immediately succeeding calendar year. A • County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor ofth•"`r/ i
wham the properly is located during the twelve(12)months before March 31 of each year the:::.• .C 1 . ��TA
See reverse side .. :..ibonalinstructionsandquarfica(ions. OUNTYA(IprTOR
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....:nt(awn: m con,- see on rse side
T. � ', ' Kaye/ dtl9acn(!7 //O/�.�0/n 5 6 Reryrd�nurr�er Page number
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Assessed value d , real property as of Mortgage I d Contract, indebtedness unpaid as of Mortgage f Contract indebtedness unpaid as of Is the or equam e the sole
e
assessmem dam, assessment date,arreM year date of legal or equitable owner?
�0(..il J 6 3 / 79 ❑ Yes ❑ No
If ro,what is his I 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,Skate below: Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller / '_G!/'/�/1 / �jl�^� '/' ��/ _
Address of mortgagee or contact seller(a tuber and street city, ,a P code) .
Name of assignee or other owner or holder of mortgage / -Address of assignee(number and street city,state,end LP code) L/
Does applicant awn property in any if yes,what county? what Taxing District? Has this deduction been requested If y e)mount of deduction
other on property for
in Indiana? Yes El No current yeah ❑Yes ❑No
A person is not entitled to rerson's mortgage or contract indebtedness that is recorded in the county
recorder's office(inctudin aunty recorders office)that is the basis for the deduction.
Drawer NO..... / El UDITOR
Deduction approved in the:
20 _ Card lNO. ...... .3;2-- - 20 20 20
Signature of County Auditc 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 t contract obuyer/off the aforementioned property on date application is(died.
Sigpature`��U� _ P Date(month,day,year) •-
ug r dress fi anll//nuummber/ and�street°Ty_state,and LP code)
'` SAD 7 /✓es,- F14 S¢, --? /Mkc /X 5/7 66
Person authorized by dent 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)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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