HomeMy WebLinkAboutMortgage_Leeds ,0:1c;4:,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Canty Township Year
c FOR DEDUCTION FROM ASSESSED VALUATION
State Fan,437w(R13/10.15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: 4 i i )
To be filed in person or by mall. Form filed with:
Firing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sough77l„�,c �.F�
Must be filed or postmarked with the County At tar or County Recorder of the county where the pro tkity la 20160 County Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 County 2) Mobile/Manufactured Homes not assessed as Real Properly.Must file with the County Auditor of Or county` Recorder
where the property is located during the twelve(12)months before March 31 of each year the ded
See reeverrse side f forradddional instructions and qualificatons. CIDCON COUNTY AUDITOR
Appr�ntl Y`-W --' restrictions.reson cis
T District ,. Key number/legal Remit r Page number
fLont 07,-) 2- - /9 -/e — ,boo -oo /. 06 G - ooL i y1?g
A«edval ue of real property as of Mortgage/Contract indebtedness ahead as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year ,®d date,amend year date of application legal or equable owner?
/SD /I O 0 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant,indicate below Is the property in question:AnnualyAssessed
❑ Real Property ❑ Annually Assessed
Mobile Fiume(IC 6-1.1-7)
Naroe d mortgagee acontract Seiler T
Address of mortgagee or contract seller(number and street,city,stale. code)
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and street ray,state,and ZIP code) aO I f LA-19.Z
Does applicant own property in any If yes,what county? What Tadrg DsstrcC f `V b
other county in Indiana? ❑Yes ❑No !,at__t___E. \ !-_° 44-1>.\��'i`._
A person is not entitled to this deduction unless the person has a balance on ft \ _
recorder's office(including any home equity fine of credit that is recorded in the IC . Le ax..s Q___•-11 w
COUNTI �� V
Deduction approved in the amount of
20 20 20 20 Z 150 OO(( a U
e '
Signature of CormtyAt ddw \ ' 1 \o
/We certify under the penalty of perjury that the above and foregoing irdoy
owner/contract buyer of the aforementioned property on date application i
Sign ( mers name
XFtdl resident address of applicant(number and city, and ZIP code)
oho E:. inn i ao 161 ta,2T A-Kvtl-/ 47
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
I
Address of authorized parson (number and sheet,tTy,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.