HomeMy WebLinkAboutMortgage_ODell (2) ,.}. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
It;i FOR DEDUCTION FROM ASSESSED VALUATION 7
"•" ry'h Plats ibe 43709(R13 m 10-15)
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Ste, Prescribed by Department of Local Government Finance ED
INSTRUCTIONS:
File Mark
To be filed in person or by mail. O C T 7 Q 9n Forrn filed with:
Filing Dates' 1) Real Property Must be completed and dated in the calendar year for which the dedt7cbbrflYsought `,.J.,
Mist be filed or postmarked with the County Auditor or County Recorder of. = county where the property is KI County Auditor
located on or before January 5 of the immediately succeeding calendar ye-J •
2) Mobile/Manufactured Homes not assessed as Real Properly:Mu P , ‘171:7414,.r of the county County Recorder
where the property is located during the twelve(12)months before A M37Nf `p AW-, • A b-- ". is sought
See reverse side for additional instructions and qualifications.
Applicant(owner r cdhtract buyer=see ti,nciesile IrnA ,
\sctrent5tiin
I 1JCVl /)—l0(-500 —cam g&S'O&7 l�r Page
Assessed value of real prZty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the
assessment date,anent year assessment date,current year date of application /,,(^tt � legal or equitable owner?
I ' W TSa ❑ Yes ❑ 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: I Is the property in question:Annually Assessed
fl o..-'r-_---. —Ty Assessed
Home(IC 6-1.1-7)—
Name of mortgagee or contract seller G o a ,K/a o �- R 3 y
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) `` O
CPQt"-
Name of assignee or other owner or holder of mortgage
'F'\R L \4 sa O
.CJ
Address of assignee(number and street city,state,and ZIP code)
\D —\ 0— \\o
Does applicant own property in any If yes,what county? What Taxing District? HHn Has it isedee Acton been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No aurent 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 office(including any home equity line of credit 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
Sgnamre of inty.. ..itor / . County Date(m,• , day,
I I We certify under the penalty of perjury that the above a • •regoing 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.
S rev name Date(month,day,year)
u1I resld�dres of apprxant(number and street,city,state;°ZIP code) _
,�n' JJ/335. -3rd 5 t rr n/CC-�'onl 1/ / 4/76
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 street city state,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000.