HomeMy WebLinkAboutMortgage_Greene jate, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
FOR DEDUCTION FROM ASSESSED VALUATION y 4 �f
'� State Forth 43709(R73!1615) 1 1Y Jifl
Presrnbed by Department of Local Government Finance
INSTRUCTIONS: MAR 3 0 2017 File Mark
7b be filed in person or by malt Form filed with
Fifirg Dares: 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 cou em flu &• ' ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. I( , e,211r.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file c4t4* - .''7 'ernr.h irpt�R ❑ County Recorder
where the property is located during the twelve(12)months before March 31 oTearh year s . • rs sought
See reverse side for additional instructions and qualifications.
Appbnnt(owner or contras buyer-see resei W'ons on revs side)
`Toh n µ bre P n ,P
T(aryv�9_ District T' Key number/legal description `-/-'1 662.7 Record number Page number
Assessed value of real pfroperty 7ter / as of 10-0q e V Contract indebtedness lO /� unpaid Ls'of Mortgage 1 Coa indebtedness unpaid /of`l Is the applicant 59 sole .
assessment data,current year assessment date,cement year date of application I legal or equitable owner?
177 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If armed with someone other Man spouse,indicate with whom
If name on record is different than that of applicant indicate below. Is the property in question:Annually Assessed
❑ Rea/Property ❑ Annually Assessed
' - —
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sell __p Iv ---TO (`�`'
Address of mortgagee or contract seller(number and abeet tie,an ZIP co • P �, N e'e 1ke or\1�� 11,
Name of assignee or other owner or holder of mortgage O �� '�'4.IN 1�
1 t�o (a, O 0
Address of assignee(number and street city,state,and ZIP code) a0 `, Col S.
•
Does applicant own property in any It yes,what county? What Ta> Z` �` n date amount of deduction
other county
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contras m,.,.., it 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 ob
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 coned and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Sig,C, re> i full name) Date(month,day,year)
_rr-i� i ,/_ _-,e
F ' resident address of app" t(number and street city,state,and ZIP code)
, 9781v d°-- �.�t S ,64 t/ 3/76 7e
Person authorized by duly executed Paver of Attorney or by IC®t.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 S10,000.