HomeMy WebLinkAboutMortgage_Decker ,l STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coon Township Year
` `-= FOR DEDUCTION FROM ASSESSED VALUATION
5
Prescribed by Department of Local Government Finance
INSTRUCTIONS: i r` "'i�)
To be filed in person or by mall Form filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought. lt��II Rti
Must be filed or postmarked with the County Auditor or County Recorder oft he county where the pmpe�ll - 9 tuu County Auditor ,
located on or before January 5 of the knmediatey succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the ❑ County Recorder
where the property is located during the twelve(12)months before March 31 of each year the•-. -.1.,- r i,.../.-lifgniit -
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
riw
Appnt(ownerorrontradbuyer-see �-" .side) -
a-
Taxig 7 Key numbs/legal desaip4on� 1 ( Cl- /
Record number Page number
al, -/1 - J 0 - `fail ooO. A6,6 -aJ.. / 17 A'-16
Assessed value real of Mortgage/Contract indebtedness unpaid as of - Mortgage t Contract indebtedness unpaid as of Is the applicant the sole
assessrrnart date,aamm assesanerd data,and year date of application legal or equitable owner?
//&1 0 00 ❑ Yes/❑ No
N no,what is his/her exact share of interest? It owned wi ti someone other than Veins',indicate with whom
•
if name on record is d'ffeen than that of applicant,indicate below. Is thwerEtroperty in question:Annually Assessed
eelProperty ❑ Annrally Assessed
Mobile Home(1C 61.1-7)
Name of mortgagee or contract seder OxL ✓ �� _
-
Address of mortgagee or contract se (number and street,city,state,and ZIP code) a-�contract der
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and sheet any,state,and ZIP aide) •
345'5 ID So ,3 `f? to lo_S .
Does applicant own property in any C yes,what county? - What Taxing Distil? Has this deducroeTheen requested If yes,slain amourd of deduction
it�ana? ❑ current❑No - rent year? ❑Yes ❑No
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(lndudug any home equfy fine 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 ' �, I, n g71 it
20 20 20 20 20 p/-?lift I �,C V
Signature of CountyAudtor County ,-/(/ (.7
J (ill
I/We certify under the penalty of perjury that the above and foregoing informabpn is true and coned and f .
owner/contract buyer of the aforementioned property on date application is Wed.
'\Signer owrhefs�namep _ n,..nmh,day,year)
Ftd ant address of applicant(number and street,city,state,and ZIP code) I _
'Y S`\c6S w 3o0 5 ovJewu:We- IF gl64C
Person authorized 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 street d state,and ZIP code)
The penal ties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. --