HomeMy WebLinkAboutMortgage_Havill n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
mss. ' state Form as/m(Rta/tats) i
Prescribed by Department of Local Government Finance IL 21))
GISTRUCT/ONS: File Mark
To be filed in person or by mad MAY 3 0 2017 Form filed with:
Filing Dates: 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 CountyAuddor or County Recorder of the county wham the property 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 fife with the County s
r,�j Corm Recorder
where the property is boated during the twelve(12)months before Marctn 3f of each yB�dppgy(7yp�{quy(n(.j DITO R .
See reverse side for additional instructions and qualifications.
Ap.dcapp:e - on eve se std - /Ct
I ' `_Key number/legal description �( Record number Page number
47%21. e2 — /al - o ? - .300 - Oo1. 7SS 0a7 - 0a g `I//
Assessed value of rat property of 'I°�Mortgage I Contract indebtedness unpaid as of • Mortgage I Contact indebtedness unpaid as of Is the apl�adt t solo
assemrerd date,current year asst date,cement year date of application !'� legal or equitable owner?Ps ao0 ❑ Yes ❑ No
If no,what is his/her exact sham of interest? If owned with someone other than y+ryigi.,indicate with whom •
If name on record is different than that of appbant,indicate below. Is the property In question:AnnualyAssessed
❑ Real Property ❑ Armuapy Assessed
Mobile Nome 0C 61.1-7)
Nam of mortgagee or contract seller q,p ‘1A t-12
Address of mortgagee or contact seller(number and street,city,stale,and ZIP code)
•
Name of eaeigneu or other owner or holder of mortgage '
Address of assignee(number and street idly,state,and ZIP code) Nor V.1 �.L, a,Address - .
Pr .5c& 9- A -(o t Ion 2 .
other�t own property in any If yes,what county? • �` A (-0 Ued If yes,state amount of deduction
inbdiana? ❑Yes 0 N • ()Lb 1)ai1-v IQI�Z S4ZyINo
A person is not entitled to this deduction unless the person: ,j�,r��O p;7 rtedrress that is recorded in the county '
recorder's office(including any home equity fine ofaedd th; 4Yp( 3sis for the deduction.
WVf.•noses,VA -
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor Curtly Date(month,day,year) • .
I 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 afo(emennttioned property on date application is fled.
Y Signalers(owners kA7n- re . Data(month,day year)
xFur ddressof�card(number and sneer,' city,state,and ZIP code)
3g ' . S /° ) p J)- ton Ii 11-710 70
Person authorized by&Ay executed Power of Attorney or by IC fi1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street°Ty,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.