HomeMy WebLinkAboutMortgage_Bales 7. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-r S FOR DEDUCTION FROM ASSESSED VALUATION FIT 1. g
-` -.` State Forth 43709(R13I 10-15)
F ` T /E I'i
'„f Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
76 be filed in person or by mail. OCT , 7iv.,
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is A • •Un • ditor
located on or before January 5 of the immediately succeeding calendar year. • a ��
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of tg- nu r ''• ' ��ny' my Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduch8 '.k,,..O - ' '
See reverse side for additional instructions and qualifications.
Ap t(owner or contract•. -see onyreverse s�i/d�/e) y�J I{/'�11 (}(r'�
I 1 t LX B °� VI Q X J {�J
Taxing D-, ) Key number I legal description Record number Page number
Ulla L• r's.r - _ •- — H — D s- i_r_a. . - — a _ a • . 3G.1
• ‘..-z..value of -.property as of Mortgage f Contract Indebtedness unpaid as of Mortgage I Contract inde•edness unpaid as of Is the applicant the sole
assess - date,. - year assessment date,anent/year data of application legal or equitable owner?
If no,what is his I her exact share of interest? ��-' D a� If owned with someone other than spouse,indicate with whom No
•
If name on record is different than that of applicant,indicate below: I Is the question:Annually Assessed
r" \c„, ❑ Annually Assessed
Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller - _� `- \ P _ Q�-vc o' - - -
Address of mortgagee or contact seller(number and street city,state,and Zf1
.\..r..1/4. <-2--,\c-5 -\o
•
Name of assignee or other owner or holder of mortgage 3 O O O _`tv
74 5 1 � �'
Address of assignee(number and street only,state,and ZIP code) ao\L. l--Th-A
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
in Indiana? ❑Yes o current year Yes ❑No Pr°PeilY
A person is not entitled to M 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
Signature of County Auditor County Date(month,day,year)
I 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 r•-ct buyer of the aforeme tioned property on date application is filed.
Sgnalu .MI . )-) Date(nror r,day
1/4-cFp
k/nt'address ,c�\m�e7-t-- �Q�O jio�a-7iG
(
/gad of t(�m dV1 LLI..0 [ "
P n autlhorizetl by duty exewied Power of Attorney or by IC&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 half years and a fine not to exceed$10,000.