HomeMy WebLinkAboutMortgage_Miller (28) e%It. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
t FOR DEDUCTION FROM ASSESSED VALUATION
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State Font 43 10-15)S�� Presorted by Deparb nent o f _-
Local Government Finance F I WI
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INSTRUCTIONS: 1 I
To be filed in person or by mail. - - Form filed with:
Filing Dates 1) Real Properly.Must be completed and dated in the calendar year for which the dedudimv sqp L vvv---��1
Must be filed or postmarked with the County Auditor or County Recorder of the county 6 lie f6 is unty Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cou 14 uditor of the county
where the properly is located during the twelve(12)months before March 31 of each ylic;r; ^-�"';•'a,1- ::... t
See reverse sit .: additional instructions and qualifications. g • a"nlh
Applicant(o . : . s reverse de) J� 1'URTY AUDITOR
` ' Page 9Tioa '
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Record S5-
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I 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?
❑ 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 Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Agcecsed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee contract seller 1 n ' --_'r1 `�—
Address of mortgagee or contact seller(number and city,state,and ZIP 1f�I,Yk\°) ca O it - _
'Is
Name of assignee or other owner or holder of mortgage
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Address of assignee(number and street city,state,and ZIP code)
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1(e l( h e� ` . i ((er
Does applicant own property in any If yes,what county? What Taxing u V' N 0 ,ta amount W deduction
other I r-
in Indiana? Yes ❑No I,— ,se,_C.
A person is not entitled to this deduction unless the person has a balance on the person's mortgage r„ _ :is recorded in the county
recorder's office(mduding any home equity line of credit that is recorded in the county recorder's office)that ra ;eduction.
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/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 1 contract buyer of the aforementioned property on date application is filed.
Signature I name) Data(month,day,year)
I resid.,address of applicant( u and street,city,state,and ZIP cod:
7 E M ArrSnme-,
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,slate,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.