HomeMy WebLinkAboutMortgage_Debenport ,p, STATEMENT OF MORTGAGE OR CONTRA IJ 4J t. County Township Year
FOR DEDUCTION FROM ASSESSED VALU��lAAA111TIdONN /
S aFom437�(R,3I,o,5) NOV 14 2016
Prescribed by Department of Local Government Finance
INSTRUCTIONS: /�
File Mark
To be filed in person or by marl. ,/)[ Form filed vilify
Filing Dates: 1) Real Property.Must be completed and dated in the Calenda4y�[ c ' n Is sought.
Must be filed or postmarked with the CounyAuditor or kilihThSokljihiffiffiaRthe property is. �7Courdy Auditor ,
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/ManufacMed Homes not assessed as Real Property:Must file with the County Auditor of the county any Recorder
where the property is located during the twelve(12)months before March 31 of each year the is sought .42.t Ata
See re�verssee seidde or Centred bwer-pit restrict/ars for additional instructions and ggquualiications///�,,/ ,.yr�„ n�
no7KeriM Q (�J..m side._eipm `���QJ��o 1 9 e2 1J
T District Key number/legal desaiptun . . numberT 9fl nu�er
071 j 07 7-01- 'ywb crag. /87 OcR 1
Assessed value of real property as of Mortgage I Conrad indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of is the appicant the sole
assessment dale,current year assevrumd date,cement year date of application legal or&pliable owner?
oft3tzDd ❑ Yes 0 N
If no,what is his/her exact share of interest? If owned with'sorreone other than trx"MP.indicate with whom
If name on rend is different than that of applicant,indicate below: Is the property in question:Annually Assessed
56 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Nave of mortgagee or contact seller IJ,J
nee'cla ES COO Address d or cordrart se0er t(number and street city,state.and Z1Pcc e) .
/1 iY'2L6/P�/J� /,t'r/t 011772/4Q85-23A1//2
Name of assignee or other owner or holder of mortgage '
Address of assignee(mcnberand street,thy,stale,and ZIP code) •
Does applicant own property in any If yes,what county? . What Taxing District? Has die deduction been requested If yes,state amount of deduction
other
Indana�? ❑Yes ❑No - cement�? ❑Yes ❑No
A person is not entitled to this 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 wally fine 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 CourdyAuditw Canty Date(month,day year) •
I 1 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.1 the aforementioned property on date application is fled.
( SA -vj- Data(month,day,year)
tl t r 6/13* - 9/90 9G,/
Full resident address• applicant(number and street,city state,and ZIP code)
?C_ S.i4D S 700W toiro4sv1tir , IIJ 47!65
Person authorized by duly executed Power of Attorney or by IC 6-11-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet ply,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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