HomeMy WebLinkAboutMortgage_Schaefer (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Towhi
' `= FOR DEDUCTION FROM ASSESSED VALUATION If'jjJ ns Year
State Form 4370g(R13110.15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: 0ctile Mark
To be filed in person or by mail. 1 f I . 't.f;.with::
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction sought.is
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property
■ County Auditor
located on or before January 5 of the immediately succeeding calendar year. I•. -1111/14,— "
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor r$ fy� •unty Recorder
. rm the property is located during the twelve(12)months before March 31 of each e deduction�is so
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See reverse Si.: •r additional in lions a �nquualifications. �� t 1`h[�J I
Applicant(• �wp contract buyer- //L,��a /1ll..rr�l / a/
T.•: • r.-. - 1 17/ 3 aa3-soca Sol
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Assessed -of real property as d Mortgage/Contract indebtedness unpaid as of<Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment dare,current year date//000/ft�R3/aloblication rs— legal or equitable owner?
9 , 2 ❑ Yes ❑ No
m no,what is his 1 her exact share of interest? If owned with (soomeone other than ndicate with whom
if name on record is different than that of appG ant,indicate betrnr. property in question:Annually Assessed
eal Property ❑ AnnuallyAssessed
• Mobile Nome(IC 6-1.1-7)
Name of teeton2t Iler l/�1—f////Address (number and street city,state,and ZIP code)
Name of assignee or other owner or holder of -' -
Address of assignee(number and street • , -c ; •LP )
alf
Does applicant own property in any If —,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No a rrrePr yean ❑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. I
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 1 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
Klil owner I contract buyer of the aforementioned property on date application is filed.
_.\\Signatu . -full name) {/I/y1II .pl� Date(month,day,year)
Furl r_•47147\4
of appf�h[(number alld street,dry; --./•LP code)
fi ‘ �.53 S 1iS N-U 4 ► f- Branch IT,vl L-17 Ulf %
Person authorized by duty executed 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.