HomeMy WebLinkAboutMortgage_Ritz STATEMENT OF MORTGAGE OR CONTRACT INDEBTE E .jif n Township Year
�i� FOR DEDUCTION FROM ASSESSED VALUATION 1 j ;v
tt" State Form 437( (R13 t 10-15)
Prescribed by Department of Local Government Finance 14 Z°�
File AN
Fe Mark
To be filed in person or by mail. Fonn fled with:
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the•eduction,;. " ie ht.
Must be filed or postmarked with the County A Auditor or County Recorder the L�, p --:;�"t?, my Auditor
located on or before January 5 of the immediately succeeding calendar
2) Mobile/Manufactured Homes not assessed as Real Property.Must fie Auditor of the county Count Recorder
where the property is located during the twelve(12)months before Mardo7 each year the deduction is sought -
See reverse side for additional instructions and qualifications.
t(owner or contract Wye(-see restriclicns repy5e side)
amJr? Ott Ke
Taxag District Key number/ Rand number Page number
�•C--h a /0- ,c- 025/-are CFO S'Xa e-, 026, 02 399
Assessed value airs properly as of Mortgage/Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,=rent year assessment date,comsat year data of application legal or equitable owner?
Lt 8'006 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than 1,n,led.,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Property ❑ M� 1.1-7)
Name of mortgagee or contract seller
f°_ TF- CU
Address of mortgagee or contact seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder ofrortgage ' it3cCl - --
•
Address of assignee(number and street ay,state,and ZIP code)
. CI rCu,_ .
Does t awn property in any ryes,what county? What Taxing District? le' 1.--(C? 0 O a 0 n - .33°1 mow,
in Indiana? ❑Yes ❑No I la- S - I-1
A person is not entitled to this deduction unless the person has a balance on the pars n the county
recorder's office(including any home equity fine of area that is recorded in the count
•
COUNTY AUDITOR "
Deduction approved in the amount of
•
20 20 20 20 20 20 20
•
Signature of County Auditor County 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 of the aforementioned prop- d lication is fled.
Signature( e) Date(mop,day,year)
y i 41—/7
Full resident address of applicant(n�urn�er street city, P cod0
'C "-�00 S Vt/Csi ru Q.t/Z2kme_} 376 3'8" .
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized number and street code)
- -- ----
person (number alit:state, ZIP Code
The penalties for perjury can include imprisonment up to two and a half years and a fine riot to exceed$10,000. -n_