HomeMy WebLinkAboutMortgage_Rahman STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION .
�'i" Ps Fenn y e )
Prrescdbed bD �rtment
of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by marl nt�rC c'r pt� 'I 'r� Form hied with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the dbtlaktioN id s21A.
Must be tiled or postmarked with the CountyAudtor or County Recorder of the county where the property is My Auditor ;
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property Must file with the • '. r i - county ❑ County Recorder
where the propertyis bested during the twelve(12)months before March . 1irk r��Y AUDITOO Rat •
See reverse side for add • al in-. n:gas and q -•/: :.ns ttl3SS
Applant(owner or.. _ -sad; -
�� I t</` ..,/�^'� ) v l
legal'. /a'/Y/— 0) CO oa?. /3/--ca7 Record r- 3 55
assessment dam o year as of , assessment indebtedness00as a£ date of aj 1 Contrail irq¢btedrwss rmpaid as of le th appfaN e the O sole
�prtrVxl t ayEd.aliu,i legal or equable awneR
❑ Yes ❑ No
If no,what is his I her exact share of interest? / If owned with someone other than.prnisa,indicate with whom
If name on record is different than that of appfiand,indicate below. Is the property in question:Annually Assessed
0.-Real Property ❑ Annually Assessed
&4(X /� /q►
Mobile Home(!C 6-1.1-7)
Name of mortgagee a contract salter Address of mortgagee or contact semi(num t eanddsteet,cityste. codee)/t/ /f,/(,�r/1 i(..�
Name of assignee or other owner or holder of mortgage • ill///
Address of assignee(number and street aEy,ate,and ZIP code) •
Does: -- -----I -a-•A•--- —__ I What Taxing District? Has this deduction been requested If yes,state amount of deduction
other r A on property for
m Inch unit in Au, current year? ❑Yes ❑No
A pea rli M I CLSdtrDf4 k) a balance on the person's mortgage or contract indebtedness that is recorded in the county
MO= :recorded in the county recorder's office)that is the basis for the deduction.
Dean 1 10-3 COUNTY AUDITOR "
20 20 20 20
y&bot2c. '•
Signature of Co ity • r County Date(month,day,year)
I I We certify under the penalty of perjury that the above a d foregoing information is true and correct and that the applicant is a resident of Indiana and
owner!.. .1 .ct buyer of the aforementioned property on date application is filed.
ii:, .) Date(month,day.year)
F e'. address of apphoent(number and sheet,city,state,and ZIP code)
6' +7A %"sou Inn 2e41P. �ilncth-, n q7670 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 LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10.000.