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HomeMy WebLinkAboutMortgage_Lawrence • ,p. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ;�,Cy. Township Year `.v=.S .FOR FOR DEDUCTION FROM ASSESSED VALUATION 7 State Farm by Department s) �� �`" -- Prescribed by Department of Local Government Finance Tobe filed in person or by mail. NQV ti 1 2��6 File Form filed 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 CountyAudllw or County Recorder of the county is . -the.!'rj'�,' of ❑ County Auditor , located on or before January 5 of the immediately succeeding caendar year. 1 VD11 2) Mode/Manufactured Homes not assessed as Real Property.Must Me wih the County �J•.•u tlS Y unty ❑ County Recorder where the property is located during the 1weh (12)months before March 31 of ea v:,e : •-•union is sought See reverse side for additional instructions and qualifications. • Applicant( or contact buyer-see restrictions on mverse side) Tarring Key number t le�description Record number Page number (6 � 0,26 _,,,,_,,?_ °3Cc - COO /17;5 - oa 7 /� - ,53�d Assessed value drawl of Mortgage/Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,oment year assessment date,anent year date of application legal or equitable owner? -7/(9 y / ❑ yes ❑ No • if no,what is his/her exact share of Serest? / if owned with someone other than spouse,indicate with whom . If name on record is different than that of appEtant indicate below: Is the property In question:Annually Assessed ❑ Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Narrc of mortgarricontrastanseiter Address of mortgagee d seller(number and city,state,and ZIP code) • Name of assignee or other owner or holder of mortgage • i Aw 2E`Uc e , ()4;G43 Address of assignee(number and street a y,stale,and ZIPcocM) ,ApMES C, Does applicant awn property in any If yes.what county? - What Taidng District? lb— 3 3 („) S of deduction other in Indiana?` ❑yes 0 N A person is not entitled to this deduction unless the person has a balance on the i led in the county recorder's office(mdudng any home egtuly fine of eredd that is recorded in the a_.., . COUNTY AUDITOR • - - Deducion approved in the amount of 20 20 20 20 20 20 20 Signature of County Auditor County Date(manor day,year) I!We certify under the penalty of perpny that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and owner!••-•... buyer of the aforementioned property on date application is filed. Date(month,day,year) F e .--'•eat of applicant(number and street,city,state,and ZI?code) .y 2aN.@roue 3r- ©a-ttand CI Ell r 2-A/ ertk,6o 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 clay,state,and ZIP coda) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.