HomeMy WebLinkAboutMortgage_Neufelder (5) c STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE ip Year
'- FOR DEDUCTION FROM ASSESSED VALUATION jw ill
'' State Forth 43769(R13l 1415)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: DEC 2 7 2016FIe Mark
To be filed in person or by mat. Form filed wilts
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is so ht.
Must be filed or postmarked with the CountyAuddor or County Recorder of the county u�lera l orme !is#i!— C) County Auditor ,
located on or before January 5 of the immediately succeeding calendar year. � (C;; nI -}CN{tl1.A nn
2) Mobile I Manufactured Homes not assessed as Real Property.Must file with the Ccutg IP itor ffj,�uyrttUD I-OR Recorder
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
S--reverse side for add al instructions and qualifications.
•
,may owner.� a �er see on eve-
axh a Key n , I legal description Renard number a camber
ira f ��.Q,,,,C� . (a- 19-19-1 o I.—oqO-9sti_C. _ 1(0 4Ia0
assessment date.arrant date arrant t year edness unpaid as of • Mortgage application a indebtedness unpaid as of Is or equitable owner?
s er?
—.ad value of tital prioperty as °0060 ❑ Yes ❑ No
If no,what is his/her exact share of interest? / if owned with someone other than cpnicn,indicate with whom
If name on records different than that of applicant,indicate below: Is the property In question:Annually Assessed
❑ Real Property ❑ Annually Assessed
/� Mobile Home(IC 61.1-7)
Nacre of mortgagee or contract seller �I /� !-'t /1 n J
Address of mortgagee or contract seller(number and streeet/1c8u.staleJ' andl}-l�ZIP/•/codes/a)
•
•
Name of assignee or other owner or holder of mortgage '
s
•
Address of assignee(number and sheet,oil:slate,and ZIP code)
applicant Does p1An property in any If yes,vilest �/r---� ,w-D 4 i-c /d e V a requested If yes,state amount of deduction
other cotmty in Indiana? ❑Yes ❑No j\ I C Z ❑No
A person is not entitled to this deduction unless the t dizefrect it-11)r a n- d indebtedness that is recorded in the county '
recorder's office(indudmg any home equity fine of c a the basis her the deduction.
ti.....---v NS ui/l rr /G/1-e-A 4-r '•
Dedurbon approved in the amount of RD' S LI c
20 20 2C I l I cv 20 20
Signature of County AUffta Canty Date(month,day,year)
I 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 I contract buyer of the aforementioned property on date application is fled.
(owners fun n,a�m/e) / Date(north,day.year)
resident address of appgpnt(dumber and sheet,city,state,and ZIP code)
50� ,E - /Jul £1 . ri>rrt Mn c% %// 976W
Person authorized by duty executed Power of Aflame/or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street diy,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.