HomeMy WebLinkAboutMortgage_Lewis (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Courtly Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
1_ PresFom 4by epar/1 nto T T P
Prescribed by Department of Local Government Finance J�
INSTRUCTIONS:
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To be filed in person or by mad. �Fr 2 2016 Form Red wit :
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is so
Must be filed or postmarked with the Courdy Auditor or County Recorder of the county where the property is ❑ minty Auditor
located on or before January 5 of the immediately succeeding calendar year. •2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Aud•. r, a, -^r1^s'1yit S Recorder
trace the property is located during the twelve(12)months before March 31 o #jr ; " c UD ITO R
See reverse side fir additional instructions and qualifications. •
App (owner, or contract on reverse side) -
T District Key number/legal description Record number Page numbe
a, o4.✓� 'Z6 - / /-of - /oo - 003 . -7 A• (e - 0,0 20/ co- So6 '
Assessed vet a of real as of Nbngage/Contract indebtedness unpaid as of . Mortgage/Contract indebtedness unpaid as of Is the appEcard the sole
assessment dae,aarent year assmsrent date,anent year date of appflcalion legal or equitable owner?
/
If no,what is his I her exact share of interest? If owned wi ti someone other (at with whom
❑ Yes ❑ No
If name on rec rd is different than that of appfcant,Indicate below. _ I Is the property in question:Annually Assessed
f7 Real Property ❑ Annually Assessed
_ Mobile Home(1C 6-1.1-7)
Nave of mortgagee or contract seller �l 1 .
�f3 � � � � �ewlS �o
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) I- (�
O. 6t^r 4n e
Name of assignee or other owner or holder of mortgage .
a0Icq -sod°I I� b.a o 3
Address of assignee(number and sneel,dy,state,and ZIP code) c ca
Ia-i c
Does applicant own property in any If yes,what county? What Taxing District? Has this rty fr deduction been requested I notion
iIndiana? ❑Yes ❑No current ? ❑Yes ❑No I�
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 evilly 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 I 20
Sae of County County Date(month,day,year) •
I We certify under the penalty of perjury that the above and foregoing irdorrrlafion is true and coned and that the applicant is a resident of Indian and
owner/contract buyer of the aforementioned property on date application is filed.
/ (oxnData(month,day year)
— !(S�,�f".J�'I�lwvn /1IIA/7 sJ¢e��r/. 1 ((y,. ZIP
stet f I 1 I . (� 1 d u s 11 W 1 Ind Tr i h« -h X76, 70
Person authorized by duly executed Power ofAlcr ey or IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street a11: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.