No preview available
Mortgage_Deffendall (5) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year f "it G FOR DEDUCTION FROM ASSESSED VALUATION 1,.:. °` State FOrtn 43709(R73/10.75) S / Presrnbed by Department of Local Government Finance i {TJ FJ LED E l) INSTRUCTIONS: ll To be filed in person or by mail. Form filed with: Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought �tr-q nt Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is J t 1713 4oam+7auditor located on or before January 5 of the immediately succeeding calendar year. Ill 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder where the property is located during the twelve(12)months before March 31 of each year the deduction is __--,..----.1 ,i' t r See reverse side for additional instructions and qualifications. (y� CIBSON COUNTY AUDITOR Applicant(owner see Kytsm'rm� o�n reverse side) I/f��/'� /� /� ��.f man Taring District �Vll n� S/ J 3— y) _00 a �J 3�Va" / Record number Page numoe f Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,anent year assessment date,current year date of application legal or equitable owner? I(0 Oi ❑ yes ❑ No If no,what is his I her exact share of interest? If owned with someone ober than spouse.intricate with whom If name on record is different than that of appricant M. Is the property in question:Annually Assessed ❑Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Address of mortgagee or contract seller(number and street city,state.and ZIP code) Name of assignee or other owner or holder of mortgage ol-0i7 - cra g h Drawer NO................./../ Address of assignee(number and street,city,state,and ZIP code) Card iNO, 02 Ct Does applicant own property in any If yes,what county? If yes,state amount of deduction county other County in Indiana? ❑Yes ❑No ' A person is not entitled to this deduction unless the person. ress that is recorded in the county recorder's office(including any home equity line of credit that is few...._._ _ - for the deduction. COUNTY AUDITOR Deduction approved in the amount of 20 20 20 20 20 20 20 Signature of Canty Auditor County Date(month,day,year) I/ e 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 er 1 contract buyer of the aforementioned property on date application is filed. na (owners full name) Date(month,day,year)lif Fulllresi*nl address of r t(num and scree tiff d ZlP j L Person authorized by duty executed mey or by IC 61.1-12-00..7J{{jj����'',-�y�_�` r'l 4-) l� Date(month,day,year) • Address of authorized person (number and street city slate,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.