HomeMy WebLinkAboutMortgage_Anthis ,p., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION .
s,ht State fore 63709(p IF I E D
Prescribed by Department nt o Government of local Government Finance
INSTRUCTIONS:
To be hied in person orby mail. - Form filed with:
Ring Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. NO V 9 (�
I ,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is '•�my Auditor ,
located on or before January 5 of the immediately succeeding calendar year.
C umy Recorder
2) Mobile/Manu)acYured Homes not assessed as Real Property:Must Re with the County Auditor of the
where the properly is located during the twelve(12)months before March 31 of each year the dedutpthiSON COUNTY AUDITOR
See reverse side fore additional i 'ens and qualifications. CCii1�B6
Applicant (LC � � )
T Record number Page number
/J1J2c'�rr7 - 6�-ooa.os2 6/8 do/.5- .spa 6,
Assessed value of fast prapeny as at Mortgage!Contract indebtedness unpaid as of - Mortgage/Contract i debtedness unpaid as of. Is the appicard the rote
assessment date,ascend year assessment date,anent year date of apprcalion ,/,! legal or equitable owner?
��
eJ 7r z 66(° ❑ Yes ❑ No
•
If no.what is his I her exact share of interest? If owned with someone otter than slaw'cn,indicate with whom
If name on record is different than that of appfcar t,hcicate below. ys tog property in question:Annually Assessed
• /,y�i, e,al Property ❑ Amy Assessed
Mobile Home(IC 6-1.1-7)
None of mortgagee or am6ari setter r
e
Address of mortgagee or contrail safer(mother and street,city,state, P code)
•
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Name of assignee or other owner or folder of mortgage '
Akira l� 6...7917°�@'
Au-1-14_13, 5Aca3 m /`' ��_ 4/-j_ /o
Does: �\ M hat Taxing District? Has this been requested If yes,state amount of deduction
other c in In* JdE current year? ❑Yes El No
A pets i �^W 9 balance on the person's mortgage or contract indebtedness that is recorded in the county •
records 5 - 1 a 0 recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR • • .
20 20 20 20 20 20 20
Signature of CounlyAtddm County Date(north day,year) .
41 I I We 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 aforementioned property on date application is filed.
(owner's fug name) Date(month,day,year
Judl resident address of applicant(number and street,city,state,and ZIP code)
∎ S3S3 .N 7S E Pchki zNf 141 6 6
Person auttorized by duty executed Power af Attorney or by IC 6-1.1-12-0.7 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.
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