HomeMy WebLinkAboutMortgage_Linder (2) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Tsf ' ear
ern. FOR DEDUCTION FROM ASSESSED VALUATION tY �i
S Form 437�(R13/1ai5) ( �
Prescribed by Department of Local Government Finance JVnne d1a9k2017
INSTRUCTIONS:
To be filed in person or by mad. Form filed with:
Fir mg 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 County At dtor or County Recorder of the county where the property is. Auditor
located on or before January 5 of the immediately succeeding calendar year. G I B SO N CO U lh,ay{{))ITdddider
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County AudItor of the county
where the properly is located during the twelve(12)months before Mandy 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications. •
Appfirant or wra buyer-see re - on reverse side) 6
T- ::.*Y, � ,,y � �,�
'j�2L�xC�CTOr" A- %? /ad3 I' V- oil2 Record , Page n
Assessed value of reef property as of Mortgage/Contract- unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,arrant yea e a,i uid date,anent 03 date of application legal or equdable owner?
l(1 //3,Cap El Yes ID No
If no,what is his I her exact share of interest? If owned with someone other than wig,indrate with whom
If name on record is different than that of applicant,indicate below 1s property in question:Annually Assessed
Real Property ❑ omePsse(IC
Mobile 6
Mobile H Home(IC 61.1-7)
Name of mortgagee or contract seller
,r9o7g4t— 1-/
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of a:aiwti.,or other owner or holder of mortgage ' (///'� J /�
•
Address of assignee(number ' ,state • ZIP code)t/ / /&J / n—o` —10 yaf�fl �J .
Does applicant own property in any what county? What Taxing District? Has this deducTcat been requested If yes,state amount of deduction
other ❑Yes 0 N current year? ❑Yes 0 N
A person is not saddled 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 credt that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR " - -
Deduction approved in the amount of
•
20 20 _ 20 20 20 _I _
20 20
•Signature of County Audits' _.- Camp - - - -
I/We certify under the penalty of perjury that the above and foregoing information is this and correct and 1 II
owner/contract ..4.-r of the- ••- '- -. pro•- ' on date application is filed. a-J"` �O(n% }°v l (fit e
.mow'-$.,-(owner's tuft J-
r it J/ I� 2 ■ 13t 31. ov Ca1l1e
li •-S.: >. tl�!i g/4 /t1u�L J'� / __ d lLCn`,1
Person-authorized by duly eaeaded Power of or• IC 6-1.1-1210.• I Date(month,day,year)
Address of authorized person (number and street city state,and ZIP code) OP
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. - _ _ _