HomeMy WebLinkAboutMortgage_Mullen a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION T ED
Prescribed by Department 5of Local Government Finance y - q J
INSTRUCTIONS: " File Mark
To be bled in person or by mail. - NOV 9 " 20ifinfued with:
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 Courtly Recorder of the county where the prop: is iii.1 •. my Auditor ,
boated on or before January 5 of the immediately succeeding Calendar year ri
2) Mobile I Manufactured Homes not assessed as Real Property.Must file with the County Auditor of, .4 Imo�- ,�l rm11 r� County Recorder
where the property is boated during the twelve(12)months before March 31 of each year the<a-I.%°I' •9011.x.,-,TY AUDITOR
See reverse side for additional instructions and qualifications. •
AppGCant, (9wirer�turyer-sere i on ra ) •
T tract • Key number/legal desertion Record number Page number
026-/3:.29- aD/ 5t/d 00 /6 - `/51(6
Assessed value of mat properly as of Mortgage!Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the appirad the sole
amassment date,current year a> ,, tt date,anent year data of application legal or equilable owner?
/lit 000 ❑ yes ❑ No
If no,what is his!her exact share of interest? If owned witli someone other than y+ro,n,indicate with whoni
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
p-Real Property ❑ Nmualy Assessed
('��j'�
Mobile Home(IC 61.1-7)
Nam of mortgagee or contract setter / / !
Address of mortgagee or contact seseler`7-r(number and street city,s P e)
Name of assignee or other owner or holder of mortgage ' --- —
r / t L f
Address of assignee(number and street,aty,saute,and ZIP code)
U I L£y! 4 y J
Does applicant own property o any If yes,what county? - at Taxing District? H I ,() --- J t ea
other county in Indiana? ❑Yes ❑No a
A person is not enbiled to this deduction unless the person has a balance on the person's n Pnty '
recorder's office(mcudmg any home equity fine of credit that is recorded in the county rem
COUNTY AUDITOR " -
Deduction approved in the amount of
•
20 20 20 20 20 20 20
Signature of CowdyAudtor County Date(month,day year)
I t We certify under the penalty of perjury that the above and foregoing informafion is true and correct and that the appficard is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Signature(owners hull Date(month,day,year)
Y '/, ,,Lx t��u-Q�w- (I -G - I(,
Full resident address (number and street city,state,and ZIP code) ' Ir�
,o II II1ri E OM 5 c \aid C:d -ta ` f llp1G0
Person authorized by duty executed Poore)of Attorney or by IC 5-1.1-12-0.7 Date(month,day.year)
Address of authwzed 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.