HomeMy WebLinkAboutMortgage_Sailer STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'4'=r FOR DEDUCTION FROM ASSESSED VALUATION dun Township Year
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State Fern 43709(R13/10-15) -
Prescribed by Department of Local Government Finance F I /
INSTRUCTIONS: Ale Mark
To be filed in person or by mad. .�,,11((��\\II 1� RR 2O1S Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduc1h'+A sdtiihi.
Must be filed orposbnarlced with the County Auditor or County Recorder of the county where the propel ' Wounty Auditor
located on or before January 5 of the immediately succeeding calendar year. / a
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the Corm ^ 0b'?Ri'1 •• ❑ County Recorder
di c TOR-where the properly is boated during the twelve(12)months before March 31 of earn ..,,� 47.1i,
See reverse side for additional instructions and qualifications. GIBS i
Applicant(owner or coped buyer-see restrictions on reverse side) - -
itiattl ‘-.-5-CLASA
Taxtg " Key number/legal description Record number Page number
Assessed d - rO "ff -M Jad ` nu /O he
value dread ,ContraC o of Mortgage/Contact aMebtedn unpaid as of Is the applicant the sole
le
assessment date,arrant year assess/nerd dabs,aTare�nt year date of approation legal or owner?�fOV ❑ Yes ❑ No
If no,what is his l 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. Is the property In question:Annually Assessed
,® Real Property ❑ Annually Assessed
Mule Home(IC 61.1-7)
Name of mortgagee a 'J�`�{\��s�/J(r
Address of mortgagee or contact setter(number and street dry,state,and ZIP code) -________-
Name of assignee or other owner or holder of mortgage ' S AILlefii n.,
• R•
Address of assignee(number and street ay,slate,and ZIP code) •
Does I C7 - 48oq
applicant own property in any If yes,what county? - What Tarring District? duction
other county in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the Person has a balance on the per the county '
recorder's office(inducing any home equity fine of credit that is recorded in the county recorders wild„_._.
COUNTY AUDITOR ' -
Deduction approved in the amount of:
20 20 20 20 20 20 20
•
Signature of County Aucaor County Date(month,day,year) -
I/We certify under the penalty of perjury that the above and foregoing'udormabon is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
7 5 (ow s fwd ) Data(month,day,year)
t�LC L-- r• SJJ L. ( I-lZ-Z0U 10
Full resident address or applicant(number and sheet city,slate,and ZIP code)
7° moo C• ;11/..t S-C - ,nT 13n4,1_ic bl bu. Hi L,t 162
Person authorized by duly executed Power of Niamey or by IC 6-1.142-0.7 ' Date(month,day.year)
Address of authorized person (number and sheet cfy,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.