HomeMy WebLinkAboutMortgage_Reneer (3) .
ear. STATEMENT OF MORTGAGE OR CONTRACT IN E i v. my Township Year
iliP. FOR DEDUCTION FROM ASSESSED VALUATION i !
'' Stale Form 437 (Rl3/1415) _
Prescribed by Department of Local Government Finance
JUL 1 4 2017
INSTRUCTIONS: File Mark
To be filed in person or by mall. - Form filed with
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which led So>) f.
Must be filed or postmarked with the CountyAuddor or County Recorder o the property is ❑ County Auditor
located on or before January 5 of the Immediately succeeding calr{d1SQGM COUNTY AUDITOR ❑ County Recorder
2) Mobile/Manufacbded Homes not assessed as Real Property.Must file with the County Auditor of the county
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or trtryar-see restrictions on reverse site p
Pf� �cr — ..on-t¢n4.
It"),istrict Key number/legal desoiptmn Record number Page number
kfir— aG /a o 1 .30/ 00,3, 795 ask /7 a 9s Y
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,and year assessment date,current year date of application legal or equitable owner?
73,1 5. ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned withsomeone other than spouse,indicate with whom
If name on record is different than that of applicant.indicate blown. 1 Is the property in question:Annually Assessed
.._ r,_snn sally Assessed
Heme`�of-rtee or-co�ma se0��er'{{/`'�- [/221-A-M 7)26 L2-35A L. /C (�GC t
Address of mortgagee or contract (number and street city,state,and IP code)
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and street dry,state,and ZIP code) •
Does applicant own pr we,ty in any If yes,what county? . What Taxing District? Has this deduction been requested H yes,stale amount of deduction
other in Indiana? ❑Yes ❑No current year? ❑Yes El No
A person is not sniffled 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(induddg any home equly fine of met 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 20
Signature of CountyAudtor County Date(month,day,year) .
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 on date application is filed.
Signature(• ,. name) I Data(m1nth,day,year)
um resid- .... . of..., r. . (n and city,stale,and ZIP code) �" /�/�/�
/3-c 5- 9gese , Sr.
authorized by day executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,aiy 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.