HomeMy WebLinkAboutMortgage_Vela STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•
Altai: FOR DEDUCTION FROM ASSESSED VALUATION
-; - Stoe Far,43709(R13/10-15J .
•Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mad. Form Red with:
Filing Dates: If Real Property:Must be completed and dated in the calendar year for which the deduction is ��11
Must be filed or postmarked with the CountyAUditor or County Recorder of the county per8in I,) L County Auditor ,
located on or before January 5 of the immediately succeeding calendar year. 1BtJ�.
2) Mobile/Manufactured Homes not assessed as Real Property.Must the with the county ❑ County Recorder
where the property is boated during the twelve(12)months before March 31 of each year the deduction is
See reverse side for additional instructions and qualifications. JUN 2 0 (U)/
ormrub'ad buyer- son reverse Key number/legal '
o / a� /�- ado Cr' • "I - . oa7RSoni'co NTYF') oR Pd4,a5
Assessed value of read animal/as of Mortgage t Contract indebtedness unpaid as of . Mortgage t Contract indebtedness unpaid as of Is the apjkant the sole
assessment date,current year asessent date,current year dale of application legal or equdabte owner?
837.560 . 4T ❑ Yes ❑ No
If ro,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant indicate below: Is the property in question:Annau9aydyAsessed
. ❑ Real Property ❑ Mobie Home1.1-7)
Rerun of mortgagee contact seller /�
. `dJ� ? Winn Z� 1 Y/)11 QJLI CCX.4.-
Address of mortgagee or contract seller(number and street city,state,and ZIP code) -
Name of assignee or other owner or holder of mortgage ' _ _
Address of assignee(number and street,oily,state.and ZIP code) - LL,d / aind- a y 4-
Does applicant own property in any If yes,what county? - what Taxing District? Has l in. U- ,I l i l m
iIn�r�a? ❑Yes 0 N aantt Y. (/ 0Y"-'
A person IS not entitled to this deduction unless the person has a balance on the person's rut �� _ a , a 5 Runty
recorder's office(including any home equity fine of credit that is recorded in the county rear
COUNTY AUDITOR • _
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of CountyAurtor County Date(morel;day,year)
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 aforementioned property on date application is filed.
Signature(owner's ft&Y name) Date(month,day,year)
Full resident address of applicant(number and street city state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-01 Date(month,day,year)
Address of authorized person (number and street oay,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.