HomeMy WebLinkAboutMortgage_Vanoven STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION g ��
Staff lbe 43709 par/10.75) �j $ j)
Prescribed by Department of Local Government Finance ®g, r + g
INSTRUCTIONS: File Mark
To be fed in person or by mail p. ! :wins,
FiTmg Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be fried or postmarked with the County Auditor or County Recorder of the county where the properly is ❑ County ' •it. .
located on or before January 5 of the immediately succeeding calendar year. "i.i ri i-ecober
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the county I $
where the properly is located during the twelve(12)months before March 31 of each year the deduction LOiBQ( N -o- -
See reverse side for additional instructions and qualifications.
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Applicant(ownp a rexndmnV i` reverse side)
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anetiC/M
Taxing District ` co=i' .'—i °=io► - oO�.. ii /-oar ` I ` i` .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessnmd date,aarentyear .,.wit date,amend year date of application legal or equitable owner?
'?Ott - ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indtcate with whom
It name on rend is different than that of applicant,indicate below Is the property in question:AnnuallyAssessed
❑ Real Property ❑ Made Home1.,-7)
Nave of mortgagee or contract seller - Made n
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Address of mortgages or contract seller(number and steel T p� \
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Q.*f \c-\2U 4N`-014 EVE
Name of assignee m other owner or holder of mortgage ' S p \,
1-V iT3 VGY� [
Address of assignee(number and street al):state,and ZII
--n ,4 o0 , 00 aokco - flag . .
Does applicant ors property in any If yes,what county? _ n requested If yes,state amount of deduction
other nIndiana�? ❑Yes Dyes 11- 1-Ile ._ - _ .s 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 in the county
recorder's office(including any home equity fine of pelt that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR . -
Dedudson approved In the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Data(month,day year) •
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 filed.
tun name) Date(month,day,year)
Ci al i;ii $ dill-(41 - ./ - -
F a6d;;'Ss of" - - and street ddy,state,and ZI code) ft i
l V S � ' so cr-^"` if)C. 7<h • -
Person authorized by duty- .:,y;.. -y. it, Attomey or by IC 6-1.1-12-0.7 Date(month,day,year)
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Address of authorised person (number and street,day,state,and ZIP code)
The penalties for perjury can include imprisonment up to two end a half years and a fine not to exceed$10,000. -