HomeMy WebLinkAboutMortgage_Roudebush (2) f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s.- County Township Year
' :: FOR DEDUCTION FROM ASSESSED VALUATION
'° State Forth 43709(813110.15)
Presabed by Department of Local Government Finance u I
a.
INSTRUCTIONS:
lb be filed in person or by mail. E� Forth filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought EC 29 20 6
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
totaled on or before January 5 of the immediately succeeding calendar year •2) where the property Manufactured Homes
located during the swede(12)months March with each ctY Auditor oftl 7- ^r'?ii • •unty Recorder
Yeartb
See reverse side for additional instructions and uafdications. Y AUDITOR
t(owneror contract buyer- ;rp reverse side)
T - District Key Key/ number!legal description Record number Page number
- a( - /o 3� - yoo ooS 30 rid/ ao( (� syo3
Assessed/, of real• Contract in
- as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contradebtedness unpaid as of I Is the applicant the sole
nc eccment date,• — assessment date,current year date of application 63 legal or equitable owner?
If no,what is his/her exact share of interest? If owned with someone other than spot
wn use,indicate with whom ❑ Yes ❑ No
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Rome(IC 6-1.1-7)
Name of mortgagee`or�rc`ontttrr-act seller ��`'�''�'+�CO��
Address of mortgagee or contract seller(number and street city te,and ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Pr sE -36- a-- is 5.o /4-c
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes ❑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!me 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)
I/We certify under the penalty of perjury that the above and foregoing information is uue and correct and that the applicant is a resident of Indiana and
owne I contract buyer•• the aforementioned property on date application is filed.
kSig a",t/7/ l naml Date(month,day,year)
Vull r adtlrass of applicant(number and street dry.state,and ZIP code)
H2-l1 5)-�\t lYxo1 GS Q' -cn5J,flc -N-N3 47bes
Person authorized by duly executed Power of Attorney or by IC 6-11-12-03 Date(month,day.year)
Address of authorized person (number and street dry,state,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000. .