HomeMy WebLinkAboutMortgage_Elpers (12) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
[�L FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 637D(8131 10.15) F"I$ IE •)
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Prescribed by Department of Local Government Finance A @q..d.
INSTRUCTIONS:
To be hied in person or by mad II Form filed with
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sough!P N 3 0 201
Must be filed or posbnadced with the CountyAuddor or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile IManufachded Homes not assessed as Real Property.Must tile with the County Auditor• •- •% •r M County Recorder
when the property is located dining the twelve(12)months before March 31 of each ....or,. '1 e>y�r , ;7gj�r
See reverse side for adddionai instructions and qualifications. Yet .' •" it AUDITOR
App5ca or contract buyer-see restrictioiio ns on reverse side) - I/]�(I .� -
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y ATrJLA e �� v�/l L1 JC'VW
T D'strici Key runnier/legal desa'rytion 1�/(V\\ Record Pay
at e. •‘ Ck -31- 303-a Pa . '8 9.g-P 09 ►/ g=
Assessed value of rsal property as of Mortgage/Contract indebtedness unpaid as of . Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,arrant year date of application legal orIIf��_eeqr,,.,,uitable owner?
I °iS ( D •)-- 9J'Yes ❑ No
lino,what is his I her exact share of interest? , If owned with someone other than spouse,indicate with whom `t
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
• Real Property ❑ Annualy�Assessed
Monde Home(IC 6-1.1-7)
Naaamee of mortgagee or contact seller (� (�
a -1->Lo-tea c.PtSo ✓r`)A saw(number and sleet,city,state,and ZIP code)
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Name of assignee or other owner or holder of mortgage ' •
Address of assignee(number and sleet,cdif state,end ZIP code) •
Does applicant own property in any if yes,what county? • What Taxing District? Has this deduction been requested If yes,state amount of deduction
other ❑Ird ❑Yes ❑No amrm n 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(including any home equity fine of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR "
Deduction approved in the amount of:
20 20 20 20_ 20_ 20 I 20
Signature of County Auditor County Date(mortu,day,year) -
I/We certify under the penalty of pe• 1 that the above and foregoing in omabon is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the afo; property on date application is filed.
Date(month,day year)
tun /r1 .•.. of.. . �,. (min.:, a. 6\-ff,city,state,and code)
u` 5 t• ...r-A--0. . b11 IeC2_c.t (�\LTO �4'
P--. 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 thy,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.