HomeMy WebLinkAboutMortgage_Windell t'a STATEMENT FOR OF DEDUCTION MORTGAGE FROM ASSESS OR CONTRACT ED VALUATION
INDEBTEDNESS County Township Year
°,:'.'-. �7- State Forth 43709(R13/10-1
- Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. R 16 2017 Form filed with:
Filing Dater 1) Real Properly th
Must be completed and dated in the calendar year for which the ded t i rs sought �,/�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pro.- 1 • IdCGOunty Auditor
located on or before January 5 of the immediately succeeding calendar year. of
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cou •I• T'D` t •t r� County Recorder
where the properly is located during the twelve(12)months before Mardi 31 of each .,_.47 .gI OS t i.�A� C R
See reverse side for additional instructions and qualifications. GI6 •
Applicant(. "-
legal description Record number Page number
P . cz4 /cR ?- /6VOV d.3/ o0. k. . avi /?�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant 11;e sol
assessment date,amend year assessment date,current year date of application legal or equitable owner?
//lots ere ❑ Yes ❑ No
If no,what is his/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 belay. Is the property in question Annually Assessed
Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of moygag ee or contract seller
Lenders LL _ -
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage ei-
wlWi,e I I -f 11(
Address of assignee(number and street,city,state,and ZIP code) O n"AS d W t
Le` e.r7- 1LLC
Does applicant own property in any If yes,what county? What Taxing District? Ha t
other county on 1 n
in Indiana? ❑Yes ❑No a 1
A person is not entitled to this deduction unless the person has a balance on the person's r a 0 k-1 , La 9 aunty
recorder's office(including any home equity lime of credit that is recorded in the county recauc-,_-. ' 1; ri
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
owner!contract buyer of the aforementioned property on date application is filed.
Signature owner's fur/name) Date(month,day,year)
r° (owner's 3//to// 7-
Full resident add ess of applicant(n ter and dry,state,/a�nd ZIP code)
Person authorized by duty executed Power of Attorney or by IC 6-1-1-12-0.7 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.