HomeMy WebLinkAboutMortgage_Utley (2) ��, . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County - Township Year
`' FOR DEDUCTION FROM ASSESSED VALUATION 77T�1�
'' '� Stets lbed 43709 Department m 10-15)
o LE
Presrnbed by DepaMleM of Local Government Finance
INSTRUCTIONS: File Mark
lb be filed in person or by mail FEB 7 Fo4 et with:
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 property is ❑ County Auditor
boated on or before January 5 of the immediately succeeding calendar year. ,f l - unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cord
where the property is located during the twelve(12)months before March 31 of each year the dede@t9SODPOO U N I Y AUDI f OR
See reverse side for additional instructions and qualifications.
Appraxn` �or, contract buyer- restrictions terse s7/iid/ln/1Ie))
Taring Distend e� K Key �EsAC;elf Record number Page number
4—)a1/4/50 it) &Co a'3-/8-J49-00/O.s/- a21 /9907 /2W
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of I Is the applicant the sole — .
assessment date,amen year assessment date,current year date of application -{, - legal or equitable owner?
If no,what is his/her exact stare of interest? If owned with someone ` \e.t/1 Si Q.?h e 4, C1. a-
�l(e•, J . to
If name on record is different than that of applicant,indicate below:
tat \< 110 e i*\tev.s Qa_wk
Name of mortgagee rc•ntract seller -C-3 j1000
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? Vchat Taxing District? Has this deduction been requested If yes,state amount of deduction
�ia'annan? ❑Yes ❑No aoerrrentyear?for ❑Yes 0 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 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/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
• er 1 contract buyer of the1forementioned property on date application is filed.
Si g ' (• I, tubnanW "I Date(mon da yew) . �v'
F
F. resid= address of appf t(nun and../:, : , lie, -P.�.y I
12ito 5• D Attorney ) i ' r /' ) cam 47103
Person authorized by duty executed Power oAAttomey or by IC 6-1.1-12-0.7 Date(month,day,yew)
Address of authorized person (number and sheet 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 S10,000.
•