HomeMy WebLinkAboutMortgage_Hooker ,p STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
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FOR DEDUCTION FROM ASSESSED VALUATION
State Faro 43709(R73/,615)
V° 'r Prescribed by Department of Local Government Finance FILE
INSTRUCTIONS: File Mark
To be filed in person or by mall. DEC 1 :rri-r.,with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought.
Most be hied or postmarked with the County Auditor or County Recorder of the county where the property'- ■ •. n •nor
—.!
located on or before January 5 of the immediately succeeding calendar year. './71111•• city Recorder•
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the uditor of(f� . t'
where the property is located during the twelve(12)months before Mardi 31 of each Co�the deducbbA. 1 •.U' •. u • '
See reverse side for additional instructions and qualifications. •
(owners buyer-see restrictions on verse side) • 4
Taxing D , Key number-Kegs! • Record number
r C r_. a. eL - it - (hh-u 1 45. . — °boa (S — )C9 /C ckin9
Assessed value of real properly as of Mortgage I Contract indebtedness unpaid as of - Mortgage I Contract indettedness unpaid as of Is the apps ad the sole
assessment dale,cement year -,vim,®d data,current year data of application legal or equdable awneR
?(9) 5 b gars ❑ No
If ro,what is his I her exact share of interest? If owned with'someone other than spouse,indicate with whom
If name on record is different than that of appfrtant indicate below: Is the property N question:AnnuagyAssessed
`itRea'Property ❑ Annually Assessed 1.1-7)
Address of mortgagee or contr sew(number se (mmmberand street,city,state,and ZIP code) 13(1 E pD +L•4
Name of assignee or other owner or holder of mortgage ' `` ) �/,/�'� ,t X71\
Address of assignee(number and sheet,c'd):stale,and ZIP code) io /p i,t1 1�i'1 OI R
Does apt own property in any if yes.what county? - What Taxing District? 163 Lk,' l•�-,sate amount of deduction
ibW'ara? ❑Yes 0 N - 0jV�Yn: °_
A person is not entitled to this deduction unless the person has a balance on Me person e4 ,00 l 0 _,.r indebtedness that is recorded in the county '
recorders office(including any home ern*fine of a-edit that is recorded in the county A i Y.-/that is the basis for the deduction.
COUNTYAUDITOA
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
II 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 I contract buyer of the aforementioned property on date application is filed.
Sig eture(owner's full name) Date(month,day,year)
,
k.
F resident address of app (number and street state,and ZIP code)
is s E ae.,,j ,JR. 4,..,1 8,41-,e..A. J.•_, 4/74 St8
Person authorized by duly executed Power of Attorney or by IC 6-1(I-12-0.7 Date(month,day,year)
Address of authorized person (number and street cfy,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.