HomeMy WebLinkAboutMortgage_French c}. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
rf -12 FOR DEDUCTION FROM ASSESSED VALUATION i -- F D
.;;b �. State Point 43709(R13!10-15) �i
Presented by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. SEI 15 r.filed with:
Filing Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orposfmartced with the CountyAuditor or County Recorder of the county where the prope 1 "s , r l♦ .. - Auditor
located on or before January 5 of the immediately succeeding calendar year. , • vc1711; County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditpq pQth u�nQSt 1 NT I • •
where the property is located during the twelve(12)months before March 31 of each year the deduct—on is sought
See reverse side for additional instructions and qualifications.
AppG t(owner or contract buyer-see
Record number Page number
y(9 a.4.L-e—A ab - 2,o - } 8- .? oo -coo . 5v3 -oo/ ?oi 3coY /
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
assessment date,c u r r e n t y e a r assessment date,ascent year date of application legal or equitable owner?I a. 81 000 ❑ Yes CI No
If no,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,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 !�
J -,
Address of mortgagee or contract sever(number and city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet city,state,and ZIP code) �/
PT hi hi 9.8 - 3 - 9 a •3a �4e- Drawer NO.......C-1 ...
Does applicant own property in any If yes,what county? What Taxing District? F '' iction
dare? ❑Yes DNO c // n I
A person is not entitled to this deduction unless The person has a balance on the person's Card NO. �S'�! 9 county
recorder's office(including any home equity line of credit that is recorded in the county re(
COUNTY AUDITOF_
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,yew)
I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
X Si (owner's name) Data(month,day,year)
C G IS I b
r • eat address of app5cant(number _ sheet city,state,and ZIP code) ' \ ^7
Person teri Cby duly tC1 \-�,�£ib -0.7 Cl TJ�J �I I (()I Date(month,day,year)IC
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.