HomeMy WebLinkAboutMortgage_Conner (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Town I. Year
- FOR DEDUCTION FROM ASSESSED VALUATION ! e
(: ?"- S&-t.Fora 43709(R73/10-15) I�
Prescribed by Department of Local Government Finance Ik
INSTRUCTIONS: NOVFr e I 'ii r
To be filed in person or by marl - Form Red with:
Filing 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 County Auditor or County Recorder of the county wham the property i- • ,!7„ T ' •ttor
located on or before January 5 of the immediately succeeding calendar year. '. • r.�f0I.
2) Mobile/Manufactured Homes not assessed as Real Property-.Must file with the County Auditor of )ty co ,i «1 i il' ��
where the property is located during the Solve(12)ma before March 31 of each year the deduction is sought
See reverse sid-for additional instructions and qualifications.
Applicant(.....//•�c�on�ba'�C bb�u,yer-�9 on reverse side) - �
Page ante
i2 le0 IZ ,{/7-/d-/6/- 003. W-CJo12 / (o `Ity7
Assessed value of real property as of I Mort gage I Contract indebtedness unpaid as of -Mortgage t Contract indessadness unpaid as of Is the applicant the sole
assessment da`e.arrant year I assessmert date,anent year data of application legal or equfable owner?
0 Yes ❑ No
If no what is his 1 her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on read is different than that of applicant,indicate below: Ls the property in question:Annually Assessed
� eal Property ❑ Annually Assessed
'' `` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract setter(number
.
/�
Name of assignee or other owner or holder of me //)7// _
Drags r NO (.2° /L.F/'/ .
Address of assignee(number and street,thy,sti
/// '1. 9 i " /f d-/0 . .,.3/98
Does applicant own property in any If yes,wfi Card \O. 9 /' I action teen requested If yes,state amount of deduction
other
Indiana? ❑Yes 0 N , ,'.__,_7r ❑Yes 0 N
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 fn the county
recorder's office(including any home equity fine of uedd that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR " .
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of Courdy Roam County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is fled.
(owners lore name) - �/[,'/�'�y���(}rC1 Date(month,day,year)
F r address W tg rrl62 -tree[illy,-tat and LP e) y /
Person damned- ex9 Powe7'A _ 9 ..s a`�ont��
by duly~� Atianey or by IC 6-1.1-12-0.1441
-t1-1z�"`� 4?-11 Date(m«rrh,day,year)
Address of authorized person (number and street aty,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.
.. --
...' RECEIPT FOR FILING STATEMENT OF MORTGAGE CONTRACT IL -. 4 TG of���u contract
r
.a.. C,euu NOV 1.0 2015
r-a ...(month,day,year) Amount of indebtedness
Keyn 11ap1
o/(o—/�—/ - 0/— ' J 035-6011 i
S1gnanrte or Auditerr County R../. - p - P U1,?D�6x AUDITOR
��.v'/6 A i ir,��/till �, „..„„)z,