HomeMy WebLinkAboutMortgage_Mathew STATEMENT OF MORTGAGE OR CONTRACT INDEBTED • Township Year
"{ 'rt FOR DEDUCTION FROM ASSESSED VALUATION i i ! • I
State Farm 43709(R13l 10-15) 1 ' !'!`
Prescribed by Department of Local Government Finance
DISTRUCUGHS: JUN 0 7 2017 File Mark
To be filed in person or by marl. Fern filed with:
filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the ded q� is sought.
Must be filed orposbnarked with the County Auditor or County Recorder of the cis 0 County Auditor ,
located on or before January 5 of the immediatety succeeding calendar year. AA
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with&WOO)iaAAP rth48&?3*OR Courtly Recorder
whew the properly is located during the twelve(12)months befom March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. •
Applicant( or buyer-see restrictions on reverse side)
4tmr-tit)) cv Y') z ,, )
Taxing Disbicl Key number/legal description Record nomhar Peg
A (0-/F-- 320 --Slog coo c /nO f- ( 17 n
Assessed value of real property as of Mortgage I Contrail indebtedness iuµaid as of • Mortgage/ indebtedness unpaid as of Is the sole
assessment date,current year assessment mem(date,a year date of application legal or equitable owner?
05 5ooO ❑ Yes ❑ No
If rw,what is his/her exact share of interest? If awned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. I Is the property N question:Annually Assessed
•– — -- � rt1' ❑ MoHorte0fi(iC 1.1-7)
Nano of mortgagee or combad serer ,
� , - o —
Address of mortgagee or contract m:�(nurnber: ...street criy,s
DrawLi' NO....
Name of assignee or other owner or holder of mortgage ' .. /"1/0\
Address of assignee(number and street, state,and ZIP code) C a 1'CI .O. J/..1,(�/ l�Vil
-
Does applicant Own property in any If yes,what county? . what Taxing District? Has this dedudnn been requested If yes,state amount of deduction
other county in Indiana? DYes ❑No - current ypyeyart for ❑Yes 0 N
A person is not elated 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 fine of credd that is recorded in the county recorders 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 - Coonty 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.
hit rams) /J Data(month,day,year)
. / v /
W resident address of.,,.rn., (n .- and city,state,and P
103 la (call ;,. ' �u� • $7439
cersam authorized by duty executed••wer of Attorney or by IC 6-1.1-42.0 7 Date(mack day,year)
Address of authorized person (number and street aTy,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.