HomeMy WebLinkAboutMortgage_Asay STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
n FOR DEDUCTION FROM ASSESSED VALUATION
5 -Prescn'bed by Department of Local Government Finance , -.
INSTRUCTIONS:
File Mark
To be filed in person or by mad DEC F... ....
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. n
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cc •I ' `�'r►hii b Recorder
where the property is located during the twelve(12)months before Mardi 31 of each year the deducts r;§ G 0 r , - •.e se
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) •
T District Key number t legal description Record number Page nujobet
a6 - a23_o.t _ goo - oo). 7I3 - 0Ay AntZ `b-
value of raai property as of Mortgage/Contract'indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
date,anent year assessrnent date,anent year date of application
) legal or equitable owner?
If no,what is his/her exact share of interest? If owned with someone other than douse,�whom ❑ Yes ❑ No
If name on record is different than that of applicant,indicate below is the property In question:Annually Assessed
`J Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or amtrart miter C T r.-.C q — -. _ _ •_- --
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or tickler of mortgage ' ® ) 17-
DCa\1'1:1' 1� .
Adtl/ess of as (nut and a of state,and ZIP Goole) ,^
N LG -ry U7 PTL
Does applicant own property in any If yes,what county? What Taxing
Card \--.
azirg Distria7 -.-_--._ _ u yes,sm�amount of deduction
other county in Indiana? ❑Yes ❑No - 1ar2ont 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(mduding any home equity fine ofcredt 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 true and mired and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(„ °'vnefs full namg) � Date(month,dal:Yuan
` dikerrr ►esidJent-add Gesseoffaapplcant�Y (number eel,city,state,and ZIP code)
)C 02/C? Snail da&L &Uer 114,asiteef /rV V'7637
Person authorized by duty executed Power of or by IC 6-1.1-12-a7 r Date(month,day,year)
Address of authorized person (number and street,ay,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.