HomeMy WebLinkAboutMortgage_Colvin STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township .
9 .. FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709(R13 710-15)
Prescribed by Department of Local Government Finance I L F/
INSTRUCTIONS: File Mark
To be filed in parson or by mail DEC i mPorrf., - .
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 CountyAul:tor or County Recorder of the county where the property is ❑ County Auditor :
located on or before January 5 of the immediately succeeding calendar year. /, • a—wig w' ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of li' nlai
when the property is located during the twelve(12)months before March 31 of each year the deduction is 74 ., 0 - - ' -
n OR
See re -side for additlonnall'l instructions quail , lions.
APpica �. ... I r KC�C.�instructions
re side) .
T... ��'. Key n /legal Retard number Page i.:ri
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trn / f /O 3 Oho. 90'� 6a d6/6 /off
Assessed value al me/property as of Mortgage I Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,currant year assessment date,anent year date d l or equitable owner?
9 O S SCs . .. legal E, Yes ❑ No
tt no,what is his I her end share of interest? If owned withsomeone other than rare(es%indicate with whom
If name on record is differed than that of applicant Indicate below: Is Wj properly In question:Annu llyAssessed
Real Property ❑ Annually Assessed 6-1.1-7)•
Nairn of mortgagee or mitred seller e(21962/
Address of mortgagee or contract semi(number and street,ittt J state,and ZIP code)
Named assignee or other owner or holder of mortgage '
Address of assignee(number and street r8y,state,and ZIP code) CIS l�h��.�li�r WV
Does applicant own poverty In any If yes,what minty? - What Taxing C I ita amount of deduction
other county
in Indiana? ❑Yes ❑No
A person is not sniffled to this deduction unless the person has a balance i l(-31(08 s recorded in the county
recorder's office(includi ng any home egwly fine of credit that is recorded i duction.
COI
Deduction approved in the amount of
20 20 20 20 20 20 20
•
Signahee of County Autfitor - - Calmly 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 filed.
'li S-gnahae hit name) Date(month,day,year)
1 ./
} Full resident address of applicant(number and street city,state,and ZIP code)
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Person authorized by duty executed Power ofAttorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street aay,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.