HomeMy WebLinkAboutMortgage_Wahl e, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a' FOR DEDUCTION FROM ASSESSED VALUATION
is :f7 State Form 4byD Department ent of _
�� Prescribed by Departrnent of Local Government Finance
�J
INSTRUCTIONS: File Marls
To be filed in person or by mall. NOV ZoonEter
Rung 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 CountyAudltor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immedietety succeeding calendar year. &Corder
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of ffk�e coun��t4l
when the property is located during the twelve(12)months before March 31 of each year the dedut)I abler C 0O I AUDITOR ,
See reverse side for additional instructions and q • cations.
Mpfirant( rasQi slde) �/
fa� t7/fJtod-Quo. 093- oa6 X6 " 3
value of real property as of Mortgage!Cont ad indebtedness unpaid as of . Mortgage/Contract"vtlebtedness unpaid as of Is the applicant the sole
assessment dale,=era year assessment date,current year date of applcation //�� legal or equitable owner?/�(//,/ QUv ❑ Yes El NO
If no,what is his I her exact share of interest? If owned withsomeone other than spouse,indicate with whom
If name on resod is differed than that of applicant,indicate below: gm property In question:Annually Assessed
Property ❑ Annually Mobie(i 1.1-7)
Nary of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,ddy,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and sheet thy,gate,and ZIP code) ( C{','
Does applicant own property in any I d yes,what county? - `What Taxing District? hb been erequested If yes,slate amount of deduction
other COUnty in Indiana? ❑Yes_❑Nn_ \ LOr\ p ` amen yeah ❑Yes ❑No
A person is not em �"�a�r'-��- C‘‘
n the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(it C`�Q.v'� \ the county recorder's office)that is the basis for the deduction.
\ r c 'I Csn
,V�\ �� C ITY AUDITOR
Deduction approved i o-6\`o — `-`31_\'3
•
20 ere v /- H t�J. loll 20 20 20
\o - U - 1G- .. . .
Signature of CowdyA County Date(month,day,yew)
I!We certify under the penalty of perjury that the above and foregoing information is true and correct and t hat the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Signatltre(owners tut name) I Date(month,day,year)
.5�w��
Full resided address of applicant(number\and street,city,state,and ZIP code) "7 7! ti
7\ (PO? T�$4r ?Q_k 1Jinv.E. . fF- 3 , _TA/
l0
Person authorized by duty executed Pourer ofAttaney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authored 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.