Loading...
HomeMy WebLinkAboutMortgage_Miller (42) • • cop. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION . :t. State Farm 43709(R13/10-15) Prescribed by Department of Local Government Finance ' INSTRUCTIONS: i'e Verb' To be filed in person or by mall. prpn Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. r�c�e� Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is JU 8VZUTf Auditor . located on or before January 5 of the irnmediatety succeeding calendar year. 2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the county County Recorder where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is -. ., r.— See reverse side^for additional instructions and qualifications. • , �iTtlii • Appttrant(ownerpr cVntraC sSmstriabms rVerSe ' e K Ala ^_ GI8 50N COUNTY AUDITOR Tax g Disird 1(if�y, JTmmih_er �'�UUO' Record number Page number • - —o©iQ3 -698 . avl-7 . al'9(4 Assessed value of mat property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the appicarn the sole assessment cat°,current year assessment date,curets year date of appfmation legal or equitable owner? ❑ Yes ❑ No tf no,what is his/ter exact share of interest? /` i� If owned with someone other than spouse,indicate with whom tt name on record is(eferent than that of applicant,indicate below: Is the property in question:Annually Assessed ❑ Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Nacre of mortgagee or contract settee • Address of mortgagee or attract setter(ntmrberand street, ZIP code) - Name of assignee or other owner or holder of mortgage ' PY�� K% k-.4xI/^ Address af assignee(mm ray, (number street state,aM ZIP code) el I, J , Op � O �applicant own property In any If yes,what county? What Taxing District? I l nation in Intone/ ❑yes ❑No - r." --) I A person is not entitled to this deduction unless the person has a balance on the person's mortgage or an n.-__ ie county recorder's office(including any home egmfy fine of area that is recorded in the county recorder's office)that is the basis m,u,..__ COUNTY AUDITOR ' Deduction approved in the amount of: 20 20 20 20 20 20 I 20 • Signature of CourtyAtkiita County Data(month,day,year) I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and owner/contract buyer of the aforem= . -. pro.-rty on date application is filed. Signature • �� E, , / Data(moral,day,year) /�����/ -�� 30 AI tTh a ••••e f f ' . . -,: ., ,state,and Zl'a) -. authorized by duly executed Power of Niamey or by I-6-1.1-12-0.7 Date(month,day.)ear) Address of authorized person (number and sheet city state,and ZIP code) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.