HomeMy WebLinkAboutMortgage_Childers e ^,, i STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4,\= DEDUCTION
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FOR DEDUCTION )FROM ASSESSED VALUATION
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", -' Prescribed by Department of Local Government Finance
To INSTRUCTIONS:
pens IL�j De Mark
To be tiled In person or by mail. C�.'J.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduc con is sought Form filed with:
Must be filed or postmarked with the County Auditor or County Recorder of the county where the e r
located on or before January 5 of the immediately succeeding calendar year. MAY.11 JfJ ❑ County Auditor,
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county ❑ County Recorder
where the property is located during the twelve(12)months before March 31 of each year the eduction 's tr—
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see nofs�bons on reverse side) //
SHc+/� M. C ffic�/4/ /C Sz ct T C/fjc99,SON COUNTY AUDITOR
Toxin istrict I '�f
Key umber/le �I,d�esc,r^iption Record number Page number
26 5 r t ',vJ/ �/Ao �r,iri.5,� A. g /
Assessed value of real property as of D-0 (1 — l an �t L
March 1,current year p p Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of is the applicant the sole
March 1,current year date of application legal car equitable owner?
fa
if no,what is his/her exa hare a' terest7 / �� Imes ❑ No
.. _ If owned with someone other than spouse,Indicate with whom
'��
If name on record Is different than that of applicant,Indicate below. kkk���`�^^`
Is the property in question:Annually A sewed
0-Real Property ❑ Annua)IyAssessed
Nam of mortgagee or contract sailer/ Mobile Home(IC 6-1.1-7)
pm le IA)g-7 4 €r o/A-C It G
Address of mortg ass-or contract..seller(number and street,city,state,and ZIP code)
99CO Jfl£c4'//ictc ,en 5-.77n /- /OViry/cec Xt/ /Q2LI •
Name of assignee or other owner or holder of mortgage /
•
Address of assignee(number and street,city,state,end ZIP code)
Does applicant own property In an If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction'
other county
in Indiana? ❑Yes No on property for
current year? ❑Yes ❑IVO
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 I 20 20 20-- 20__ I 20
Signature of County Auditor • County Date(month,day,yew)
I I We certify nder 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/con ct uye f tie aforementioned, ro e
.�IC1�e / p p rty'on date application Is filed.
re(ow Date(mont�h,.,ay,yea
Full res/iden` -d s of applica�nntt(number and street,,cyity,sstate,and ZIP code
!.) 2E /n'/7 A7 fr /r r dr/c 5 y '17 4 3--Y
Person a orized by duly executed Power of Attorney or by IC 5-1.1-12-0.7
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.