HomeMy WebLinkAboutMortgage_Holzmeyer (3) 1e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Ctx1 Year
le FOR DEDUCTION FROM ASSESSED VALUATION �}�9'1�
\°,i i i State FOrrrh437�(R 1 3 tats) 1L
Prescnbed by Department of Local Government Finance
INSTRUCTIONS: DECF9'Tb16
To be filed in person or by mad. Form toed with:
Filing Dates: 1) Real Property:Must be completed and dated/n the calendar year for lahich the deduction is sought.
Must be filed orpostmarked with the County Auditor or County Recorder of the county wines the camps ., . ��_�4•-s ' .itor ,
located on or before January 5 of the immediately succeeding calendar year. m �tl•or1�'
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of theesca my O UN M A e'�I E der
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought -
See reverse side for additional instructions a .. qualifications.
owrr4ror-. f`� .,yr-oryreverse ''de))
T: �--bid ,, Key. . . / -. Record numAe Page
�' / % i --.,- ' . Oro' ed/. l J0W • „Dive 7
• _vdue of real property as of Mortgage/Contract Mdebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the appacard the sole
-,• • ,date,ascent year ear v.a=14 date,mrent year data of application ir legal or equdable owner?
C / / El Yes 11 No
V no,what is his/her exact share of interest? If owned with someone other than...conga,Indicate with whom
V name on record is different than that of applicant,indicate below. CIS property in Question:Annua9y Assessed
• Sp PAY ❑ Mobile 1.1-I)
Hama of mortgagee or contract sego Q /�e2 ! .
Address of mortgagee or contract semi(number and street city,sstate,and ZIP code)
Name of as g" ''-` owtar of mortgage .•
Address of assignee and street cdy,seta,and ZIP code) - - - .
Does applicant own property in any If yes,what county? - What Taxing District? Has this deduction been requested If yes,state amount of deduction
other courdy in UMar ? D Yes D No orient year? D Yes 0 No
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(indudmg any home equity foe of aedd that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR • -
Dedudion approved in the amount of ___________
. --__�
20 20 20 20 20;
•
Draly'el11'0..... r
Signature of County Auditor -County ...
I/We certify under the penalty of perjury that the above and foregoing information is true and Card
NO O. ..•,, 49 I
41.); owner/contract buyer of the aforementioned property on date application is filed.
...
(owner's fi➢nan.../✓ Q-1_i� �a�, o�—
al-resident resident address of-.., (n., ,.- and street city,state.and ZIP ode)•
l5J C /25Cbr ttiooOS CA( [49Y&STi"T 2>Y. w 3�(
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street ray,state,and ZIP ode)
The penalties for perjury can include imprisonment up to two and a half years and a foe not to exceed$10.000. _ _