HomeMy WebLinkAboutMortgage_Garrett (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cotlp(y Township Year
G lt FOR DEDUCTION FROM ASSESSED VALUATION 11A�1 N 1�!State FOmn by Depa rtmen� p L E N 1 Presorted by Department of Local Government Finance '� dJi-
INSTRUCTIONS: File Mark
To be filed in person or by mail OCT j i ';
; ,_ with:
Filing Oates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orpostrnarlred with the County Auditor or County Recorder of the county where the props J. • Cou Auditor
located on or before January 5 of the immediately succeeding calendar year. 11'I' q'Tf4I County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County AuditoFzJ & N
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought - e I -
See reverse side for additional instructions and qualifications.
App.:a:Eimer or contract buyer-see restrictions on Averse side) I,�1
i �f rid Da rL03>* A r A 1'��Pea
-.: • District , _ 1 Key n , .: /legal description vv Record rum Page mYr�
I ' .0� .. .y, 3 ( — lq - l- yon-coon_ I - oz ft
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Assessed value of real property as of Mortgage f Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment data,current year data of application legal o((( ��r..equitable owner?
e
- Te5 ❑ No
If in what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom `1
If name on record is different than that of applicant,indicate below. - I�s� ttw,p�ro�perty in question:Annually Assessed
- _ `�C eat Property ❑ Annually Assessed
Mobile Horne(IC 6-1.1-7)
Na of mortgagee or contract setter
Address of mortgagee or contact seller(number am
Drawer NO o76
Name of assignee or other owner or holder of nmrtg:
Address of assignee(number and street city,state, C a r d NO. 3-1 O 2
Does applicant own property�inr/any If yes,what county? What Taxing District? Has on s ttohiisadteedu requested If yes,state amount of deduction
In Indiana? ❑Yes t71V0 current year? ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co ct indebtedness that is recorded in the county
recorder's office(including any home equity fine 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
owner/contract buyer of the aforementioned property on date application is filed.
Signature(ow_rrer';lull name)#^ Date(month,day,year)
F resident reside address of applicant(number and street city,slate,and ZIP code)
554.g. LtLegure S�bcam-o,1 -.✓ v7� 39
. P authorized by duly executed Power of Attorney or by IC e-1.1-12.0.7 Date(month,day.year)
Address of authorized person (number and street city,state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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