HomeMy WebLinkAboutMortgage_Strickland (3) , � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
P FOR DEDUCTION FROM ASSESSED VALUATION
State Fain 43709(partme 15) F
Prescribed by Department of Local Government Finance
INSTRUCTIONS: 1e"""
ro be filed in person or by mall. FFo { d
Firing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. OCT 3 1 2Il lD w
Must be filed or postmarked with the County Auditor or County Recorder of the county 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 the County Auditor of the as•• ,,, -�?Rl.�i.. ecorder
where the property is located during the twelve(12)months before Mardi 31 of each year the dell - -
See reverse sill addtioyn_al�instrudions and qualifiptions.
LINTY AUDITOR
Applicant( 'L'i +Yrye -See 6" on re 72'/r f
Taxing ' 7i/ Key rlegal' (/'(/X// fiermd papa numpa
Assessed babe dreaf property as of Mortgage I Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of is the applicant the so
assessment dale.current year cobebbineut date,mrent year date of appliicafion I") legal or equitable owner?
L^/cif ❑ Yes ❑ No
If no,vAet 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. s to property in question:�Aynnnuuaallly Assessed
^ ^/ G rW � ❑ Moline Home 1.1-7)
Nacre of mortgagee 2 _ (//I'
Address of mortgagee or contact seller(number and street city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage ' _
• ac\lc,4 `fs ,t
Address of assignee(number and street ray,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this de ��� 0..�h�e T f ∎`Cc- —
Indiana?other county in ❑Yes ❑No - ameet
nyea —
A person is not entitled to this deduction unless the person has a balance on the person's mortgage \C ' a"—6—t C
recorder's office(including any home equity fine of credit that is recorded in the county recorder's c
COUNTY AUDITOR '
—
Deduction approved in the amount at
•
20 20 20 20 20 20 20
Signature of County Ararat 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/contract buyer of the . orementioned property on date application is filed.
Date(monde,day:yew
167/71/240r4-
/9 120_ A te , \/X 1717‘ 26
--. authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of au rorized person (number and stroll,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.