HomeMy WebLinkAboutMortgage_Hughes (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tPr FOR DEDUCTION FROM ASSESSED VALUATION
r State ibe 43709(R13 m 10-15)
o
Ci f, p by Department of Local Government Finance l,..„.,,��te
INSTRUCTIONS:
To be filed in person or by mail DEC 3 ( ion filed with:
Filing Dates' 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought DEC ZO p
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pm•-rty is ❑ County 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 County Auditor o 1,,• -- i r M •artily Recorder
where the properly is located during the twelve(12)months before March 31 of each year ife' •it,. "
See reverse side for additional instructions and qualifications. AUDITOR
Appruan owner or contract buyer restitutions on reverse side)
F
T " g Distriq Key number!legal c•ption Record number Page number
aCo- / 3 - a(a -Y00 - 000. 3P. ci -006 610 / 6 373.-
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole •
assessment date,current year assessment date,parent year date of application legal or equitable owner?
0 a- cq 0 6 ❑ yes ❑ No
rim
If .what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below- Is the property in question:Annually Assessed
...la Real Property ❑ AnnuallyAssessed
/{--�� • Mobile Home(IC 6-1.1-7)
Name of mortgagee or mntract seller ,', ) I Vc��y/
LX
Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code)
• -, n/(.• - 373s-
Name of assignee or other owner or folder of mortgage
Drawer 1NO...................
Address of assignee(number and sheet city state,and ZIP code)
P C .5 SE ):- a — 9 3. 33,4-C- Card NO. . —
Does applicant own property in any If yes,what county? What Taxing District? Has t ................
other on pr
in Indiana? Yes 0 N wire —
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cones __
recorder's office(mduding 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)
•
I f We •-=rtify -der the penalty of perju • e above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owne l contract • the aforeme • - • openly on date application is fled.
Signature(owner's full 1 Date(month,day,year)
)(fun resident a. -_s •0 � t(n ber an• —t,city,state,and ZIP code) I //
Li-X1 lU�l rdwe /- ?Sth s e al.(1c.J (NA JE 663
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.T' I 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. .