HomeMy WebLinkAboutMortgage_Mattox S STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
S 4 Faro 437419(R13/10-15) - FILED
Prescribed by Department of Local Government Finance
INSTRUCTIONS: .
File Mark
To be filed in person or by mar. I-�'�� 1 9 �n Form filed with:
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the.tl¢dbcdo2i2QL ht.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property.Must file wlh t� t .'of the county County Recorder
where the property is located during the twelve(12)months before Marrh 31 of :ly•nit ilit is sought - - -
See reverss ee side for addrhona linstructions and qualifications. �[y1 �GI�BSON C•UNTY AUDITOR
AppacaM a buyer r ss / O' 1G.P�I.t
s�ct
f`Ao ca Lo- 1 a - 4to.3 c�1368-o 8 Record num Pa- so'l
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Comore indebtedness unpaid as of Is the appacard the sole
assessment data,current year asessn M year
data of appfirabon legal or equitable owner?
C/O t/J1 o Yes o No
If nit,what is his I her exact share of interest? If owned with someone other than spouse,indurate with whom
If name on record is ifitieRnUhan appliicant,mdcate below. in question:Annually Assessed
ll////\\LL��JJ 7 0 Mobrle 6-1.1-7)Annually Assessed
Nacre of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) NA-FAA/31a-_ �/� /�/� X
Name of asigrree o other ownerw holder of mortgage ' 1 i • 1C0/
•Address of assignee(number and sheet,illy,state,and ZIP code) - �I' / i ) N� 7)14 � /
Does applicant own property in any If yes,what cotmtyr • What Taxing District? (//\/ /� duction
other (24 3ao`'_'
other Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the per I ie county
recorder's office(mduddg any home equly fine of aedrt that is recorded in the corn \/�,PS
COUNTYAUI Q ) ;rat-13 Lti' `
Deduction approved in the amount of l,Y U /�11/"�
29 20 20 20 /7) —d5V
Signature of CamtyAdddor Cot
-
I/We certify under the penalty of perjury that the above and foregoing irdormafrr .. Gana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) p Date(month,day,year)
utl aodr'mss of appOrant(number and steel,city state,and ZIP code)
. ) 41, Z C] Cr L e/L/ I)/9- 2, E S�-
Person authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,stare,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.