HomeMy WebLinkAboutMortgage_Dickey A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION JE'.J.IJ-' State Form by Departure 15) E D
-'`'�z Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
Tb be filed in person or by mail. J., 1 . .. =t 1 i
Filing Dates 1) Real Properly 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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the c�u�n�1y � '' �I'Ail'j, -ecorder
where the property is located during the twelve(12)months before March 31 of each year the deduction iSNEL§b11N • I • •
• J DITO R
See reverse side for additional instructions and qualifications.
Appfican er or contract buyer- orrre-'se side) n
49 i
/2?f0 7i- i / 6Q.3. lOC o - & 12- umber r /6 Pagepumber
•r= _.value of real property as of Mortgage/Contract(inirM�/ebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of SI//Iss the applicant the sole •
assessment date,current year assessment date,current year I date of appl � I egal or equitable owner?
If ra.what is his/her exact share of interest? I If owned with someone other dart ❑ Yes ❑ No
spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is th perry in question:Annually Assessed
Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
G�i '/ �
Address of mortgagee or contract seller(number and Lstree t city,state,and e)
Name of assignee or other owner or holder of mortgage
o /2) f g-0 /. oV7���
Address of assignee(number and street ci05 state, P e)
Does applicant own property in any I If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
- —� on property for
Pzc,K current year? ❑Yes ❑No
J f� E as a balance on the person's mortgage or contract indebtedness that is recorded in the county
_ it is recorded in the county recorder's office)that is the basis for the deduction.
�gMtS L COUNTY AUDITOR
I7- Ito5
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 correct and that the applicant is a resident of Indiana and
�
) owner I contract buyer of the aforementioned property on date application is filed.
Signature(owner's full non 0-- Date(month,day,year)
Full 7gsident address of apprcant(number and street city,state,and ZIP code)
/°o7 G.- > )j4 PiZy - t3 /4 9-7670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0/ 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.