HomeMy WebLinkAboutMortgage_Day (3) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County :ownship Year
'!f FOR DEDUCTION FROM ASSESSED VALUATION
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Presrnbed by Department of Local Government France gpfl
INSTRUCTIONS: '�ry18
lb be filed in person or by mail. elect with:
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought DEC 29 �y1q�y
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is U County Auditor
boated on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must Me with the County Auditor of the%r rlri '.iwviA y Recorder
where the properly is located during the twelve(12)months before March 31 of each year the c -.6:r
See reverse side for additional instructions and qualifications. GIBS N IUNTYAUDITOR
Appeca t(water era contact buyer-see restrictions on reverse 7
Taxing District L( ) ' Key number/ tzlion Record number Page number
in a.e2..-„-i- p4, - I ../g_ /o a. _ 00 i. pat i‘ -- O b 7 He 3 3 /
Assessed value of real props as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current assessment date,current year date of application legal or equitable owner?
13o, In p C) ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,intricate with whom
If name on record is different than that of applicant indicate below. Is the property in questiort Annually Assessed
❑ Real Property ❑ Annually Assessed
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Name of mortgagee or contract seller ^ , —
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Address of mortgagee or contact seller(number and sleet city,state,and ZIP code) &M�%��
Name of assignee or other Omer or holder of mortgage n/
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Address of assignee(number and street city,state,and ZIP code)
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Does
oer county own property in any If yes,what county? What Taxing District? Has property
in Indiana? ❑Yes CI No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County • Date(month,day,year)
si......
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 filed.
�S Sigpeure( rs frth name) 0 Date(month,day,year)
/
Fab r " eM a dress of applicant(n�and street, ,city, ate,and ZIP code)
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Person authorized by duly executed Power of Attorney or by IC 67.1-123.7 Date(month,day,year)
Address of authorized person (number and street city,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