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HomeMy WebLinkAboutMortgage_Dodd ,1 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count _wn J Year FOR DEDUCTION FROM ASSESSED VALUATION JL Stale Farm 43709(R13/10-15) Prescribed by Department of Local Government Finance r�1 pAprle, INSTRUCTIONS: DCG'G""7 z016 To be filed in person or by marl - Form filed 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 CountyAuddor or County Recorder of the county where the property is , W 1 .: . 'Ito/ located on or before January 5 of the immediately succeeding calendar year. 2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of tt9 r&)N C•U fR i'b er where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought . See reverse side for additional instructions and qualifications. • see restrialons on use side) 44f J OA a g iope060 ;t �4, RemC Page numbp / J007-D0 307A74 O�7 e ^ i701/ Assessed value of repl as of Mortgage/Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the appicant the sole assessnerd dab, assessment date,current year data of appfi�on �^ legal or equitable owner? l. J ❑ Yes ❑ No If no,what is his I her(nark share of interest? If owned with someone other tad rpn..cP,indicate with whom If name on record is different than that of applicant,indicate below. Is property in question:Annually Assessed • Real Property ❑ Annuafly Assessed Mobile Home(IC 6-1.1-7) Nam of mortgagee or contract seller b Address ss mortgagee or contract seller(num and street Sly,slots,and ZIP coda) Name of assignee or other owner or holder of mortgage • Address of assignee(number and street rail:state,and ZIP code) - _. . //�� / /—— J © �� ..fl 0 0/ Does applicant own property in any If yes,what county? What Ts 's,state amount of deduction other ❑No f � / -77i do �N r5 oIndiana? ❑Yes U" A person is not entitled to this deduction unless the person has a bat that is recorded in the county recorder's office(including any home egwly fine ofGredrt that is rem rj r' ie deduction. Deduction approved in the amount of of 0 /(p — 5 / rY y • 20 20 20 20 20 20 20 • Signature of County Auditor County Date(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 o f the aforementioned property on date application is filed. S4a e:(owner's tuff I*name) Data(month,day,year) FU'31• nt address of iJa.011AmberaMstreet sty,sate �)( f��y J d , ,/7� O 1X_ Person authorized by duty/W,,exec led Po of Attorney or by IC 6-1.1-12-0.7 Ur Y (v(l Date(month,day,year) Address of authorized person (number and sheet rdy,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.