HomeMy WebLinkAboutMortgage_Matthews (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun d own t Year
FOR DEDUCTION FROM ASSESSED VALUATION
f :' e Form (813111415) - I
Prescribed by Department of Local Government Finance 9 7rf
INSTRUCTIONS: E 6t1�t11a1� 6
To be filed in person or by mall. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. �rR.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly: •u7�'w my Auditor ,
located on or before January 5 of the immediate&succeeding calendar year. GIBSON CO U dilAi9Tztaliirder
2) Mobile/Manufactured Homes not assessed as Real Properly-.Must Me wrih the County Auditor of the county
where the property is located during the twelve(12)months before Mandy 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Apo/xant JO or contract buyer- restzt.ola side.
ide)
ryyy , i a � Q
r. 'ct 1(ey /legal descr�tion
Remit number Page
a of D�3/—a0d- 6°°. ?751 d� 7 c-20/6 °dY(9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment daM,current year assessment date,mrem year date of appfiratio ^� �.�✓ legal or emu�ble owner?
C.l'•/ ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than yxwya,indicate with whom
If name on record is different than that of apps ant indicate below Is yie property In question:Annually Assessed
• Real ❑ Annually Mobile H 1.1-7)
Nene of mortgagee ar contact seller `/'/'j`/'/`'�
Address of mortgagee or contract seller(number and street ' s ZIP code)
Name of assignee or other owner or holder of n. ' - - .
c�c,o,� 4 d/7 0t.co-
Address of assignee(number and street dt,,e
o q. 9-e 9 . 3/-//0 a 777i)/96
Does applicant own property in any If yes,w a O n�been requested If yes,state amount of deduction
other in Indiana? ❑Yes ❑No Drawer NO v ;n CI Yes ID No
A person is not entiled to this deduction i e or contract indebtedness that is recorded in the county
recorder's office(mdudirg any home ecru
Card 1N uC as C! )S n nfice)Crat is the basis for the dedudeduction.on.
Deduction approved in the amount of:
20 20 20 20 20 20 20
•
Signature of CountyAUddor 'County Date(mon*day.year)
I/We certify under the penalty of perjury that the above and foregoing information is true and cored and that the applicant is a resident of Indiana and
I owner/contract buyer of the aforementioned property on data application is fi led.
\'. fee dd�ar �y1)///G/2 � I Date(month,day,read
FA of applicant(n and street,city,state,and ZIP code) i� � (
j`' la et. O 4L. Q r s 61.x.- ti . -er 1 1V cxs,"1, - ) `/7 C 7 D
Person authorized by duly executed Por ofAtoney or by IC 6-1.1-1t-0.7 )
we Date(month,day,year)
Address of authorized person (number and street,a1:stale,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. -