HomeMy WebLinkAboutMortgage_Kissel STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS minty Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION W
'- Fam 437�(R73J 10.15) AR
%
— Presaibed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mall. • DEC =r ,Ap
Firing 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 CountyAudItOI or County Recorder of the county w3tere the property is
located on or before January 5 of the immediately succeeding calendar year
2) Mobile/Manufactured Homes not assessed as Real Property.Must file tenth the County Auditor ofth , , I ii! S{i,. �.
whom the property is located during the hrehre(12)months before Match 31 of each year the deduce&IFM".;. C• - ' ' • a .•See side for additional instructions and qualifications.
Applicant( orco pya�- . . t on;merse sl -
Tazat9 Dis („r'�lJt-- Key ' " number°3u l- oot.)a y-o Oct act • Record 7 7
Assessed assessrnent dale.and value d reef property yeas of Mortgage/Contract indebtedness unpaid as of . Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
�
asses % �J g extrication legal or equyase owner?
] N
�"CC))) Y ❑ Yes ❑ No
If no what is his J her exact share of interest? If owned withsomeone other than spouse,indicate with whom ,
If name on record's different than that of applicant,indicate below Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or=tract seller �\ .
Address of mortgagee or mthact seller(number and street city state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and sheet,aty,state,and ZIP code) •
Does applicant own pi out"ty In any If yes,what easily? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other in Indite? ❑Yes ❑No • current year? ❑Yes ❑No
A person is not entllted to this deduction unless the person has a ba lance on the person's mortgage or contract indebtedness that is recorded in the county '
recorder's office(including any home egtnly line oferedit 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 f 5—Q/ gc-W r�/R� �1-20 20 20 20
Dra{VC1�- NO ,.�V/ Date(month,day,year)
I Signature d Cora County
I We cenif Card No O `l irlformabon is true and caned and that the appIi nt is a resident of Indiana and
owner/car., V� �`.. tion is filed.
7 ens r roams/ Date(month,day,year)
/A/A/2O/42
ull ®..$ d ...... . ;��°� �P �r 263
authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authored person (number and street,any,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.