HomeMy WebLinkAboutMortgage_Dyer (4) ,.�,.., STATEMENT OF MORTGAGE OR CONTRACT I N
,Q'" County Township Year
FOR DEDUCTION FROM ASSESSED VALUATIO
' State Fvm 437 (873170.75)
Presaibed by Department of Local Government Finance
INSTRUCTIONS: JUL 2 7 2011 File Mark
To be filed in perm or by mall. Fenn filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for wh'.• the deduction' so .r t.
Must be Med orposbnarked with the County Aucfitor or County - i 1 :the propedy is ❑ County Auditor ;
located on or before January 5 of the immediately succeeding calendar -: .p .c.' Al j1
2) Mobile/Manufactured Homes not assessed as Real Property-.I( :to .; I h: h... , 9Lf)bT9Rie county ❑ County i2ecorder
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or see resbraans on reverse side) - -
o� n-N 111 a „ad,v�,urns
T District U Key number/legal description Record number Page number
���� & ) 5 341 yen 0O y 4-. R O 9 7 1/1 . 31(00
Assessed rave of mad as of Mortgage/Contact indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,arrant year date of application legal or equitable owner?
ap( C 00 ❑ Yes ❑ No
If ro,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
• Real Property ❑ Annually Assessed
Mobile Norte(IC 61.1-7)
Name of mortgagee or seller '1 /� ,,, •
. et'YYN- ttrti `— ll on . a w M (b Q11.1 raw .
Address of mortgagee or contact seller(number and sheet,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ' -
Address of assignee(number and street dy,state,and ZIP o nn A 2"� p/`Lot �' .
Does applicant own property in any If yes,what county? 1 l�'�f` quested If yes,state amount of deduction
other � /
to Indiana? ,Yes ❑No �"/( ' I lDo ❑No _
A person is not entitled to this'deduction unless the pet debtedness that is recorded in the county '
recorder's office @eluding any home equity fine of ere( a basis for the deduction.
Deduction approved in the amount of --
20 20 20 20 20 20 20
Signature of County A alitor County Date(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 I contract buyer of the aforementioned property on date application is filed.
Sugahue Date(month,day,year)
/�y/�/{'� 702 7/21'/
Full —.. — T• ••'. (nu •- street alSirtate.and ZIP code)
•__.. authorized by duty aracuted Power of Att rney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and steel d,: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.