HomeMy WebLinkAboutMortgage_Moody (3) �. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r_
f:::(;,_ FOR DEDUCTION FROM ASSESSED VALUATION
State ibe 43769(R13/ ent o I L It
�- Prescribed by Department of Local Government Finance F
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the'leW1uCtio8 i&r1R hL
Must be filed orpos(mariced with the County Auditor or County Recorder of throb—linty where the property is (County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with th=If•_ . •.1 ri. the county County Recorder
If c;+f8M -
where the property is located during the twelve(12)months before March 31 of:_.a.,...^ .,. ��rg/tt
See reverse side for additional instructions and qualifications. GtF(SO14 COUNTY AUK
Appriam(owner or ron`tra"ct"buyer-see restrictions on rise side) ( ,�,,
/L L number description m t�ytQ Cl in/
Tam, gpti�siri�U� (/ Key rwmber I�1 description Record number Page number
. vx X6_,,2 _ /8- - ado -000r3 3 -oaEr ao/ e0 36, //
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/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?
55i 7'-/ ❑ Yes ❑ No
If rm,what is his 1 her exact share of interest? If owned with someone other than spouse.in 5 ate with whom
tf name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
• p Real Property ❑ Mobile HAsesCefrt.t-7)
Name of mortgagee or contract se
0
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage - --- Qn� —[— ___]
Address of assignee(number and street city,state,and ZIP code) t , i . 5 5 / f"I`4.
Does applicant own property in any If yes,what county? What Taxing District? //1' �/fir ).eduction
other county - _ . Drawer-NO cX�J <-Y
in Indiana? ❑Yes ❑No
A person is not waled to this deduction unless the person has a balance on the pa - 56 i I , the county
recorders office including any home equity line of credit that is recorded in the cou
Card NO.
COUNTY AU .
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/contract buyer of the aforementioned property on date application is filed.
Sig���+'f�)(oow'n`e`rs'f`u➢name) Date(month,day,year)
Full resident adtlress'of app numb and sbvbt,city,state,and ZIP code).
x°93! S'_ S-r;0Rmra .lfT FR ,ANGrrop ' 7-N If 7G 70
Person authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7 � 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 hall years and a fine not to exceed 510,000.