HomeMy WebLinkAboutMortgage_Munro (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
� FOR DEDUCTION FROM ASSESSED VALUATION T�
'' State Farm 43709(R73/7416) 1
Prescribed by Department of Local Government Finance ._,,
INSTRUCTIONS: File Mark
Tribe filed in person or by mad. - JUN 3 0 2017 ved with:
Fifing 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 Auditor or County Recorder of the county . = :the properly is County Auditor ,
located on or before January 5 of the immediately succeeding calendar year
2) Mobl7 a/Manufactured Homes not assessed as Real Property Must file with ft,p. - ••.1,14-in.1,7!-.unfy ❑ County Recorder
where the property is located during the twelve(12)months before March 31 OPN.th n,- r^hlatignifoll&Orfah
See reverse side for add- al instructions and qualifications.
Applicant(mvneroroonpa' bri re ) CtL--k Cr °r1 u.rl1 -np�
.1 . •ict \I1L_ ln/,u�m�bner,/�-1Ce/.6di� I �� 00 —60: .to�^ D— � f r ! e
Assessed value areal prmpeny as of (nro Mortgage/Contract indebtedness-17;'s unpaid as of - Mortgage t Contract indebtedness unpaid as of 1 Is the app6cam the sae
assessmmd date,arrant year asst date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than cpcm Km,indicate with whom
•
If name on record is different than that of appfxara,indicate below: Is the property in question:Annually Assessed
//'�Y/ ❑ Real Property ❑ An nu Assessed
Nave a mortgagee or contract seller LLvLcIVjl ' I jf. '�/1 M • done(IC fr,.,_T)
Address of mortgagee or contract seller(number and street ray,state,and ZIP code)/) /
Name of assignee or other owner or holder of mortgage
Address of assignee(number street ray,state,and • '.
Drawer NO.... 6 / veer requested If yes,state amount of deduction
Does applicant own property in any tl yes,what carol
Indiana?other courty in ❑YYes 0 N - I Yes 0 N _
A person is not entitled to this deduction unless th Card NO. ,,} ) . tract indebtedness that is recorded in the county '
recorder's office(including any home equity fine a rat is the basis for the deduction.
Deduction approved in the amount of: --- -- - - - - --
20 20_ 20 20 20 20 20
n n
yt�//�JJ �� /` r°ate She a / / 1 �r , minty �k: `�."`C °"` (`� `-'--( /
I/We certify under the penalty of perjury that the above ancuaziatforrnafion is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforem- . ed pro.-rty on date application is fled.
-(. f :) Date(month,day,year)•i/ 1, ale (aroizc,(9
1 9-d.� of- •: ■(number and -- city,state,and ZIP code)
14- 9_5D cc/ 52 0 f ,f,Z.e v ccr7 di /d Y 76 7c-1
-.. authorized by duly executed Power of Attorney or by l 6-1.1-12-0.7 r Date(month,day,yew)
Address of authorized person (number and street thy,state,and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed 510,000.