HomeMy WebLinkAboutMortgage_Keller (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
P
County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
' State Form a37ae(Rtalllf-1s)
Prescribed by Department of Local Government Finance F j
INSTRUCTIONS: File Mark
To be filed in person or by marl MUG s 2°17 Form filed with:
Firing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the dedu Eon is sought.
Must be filed or postmarked with the CountyAUddor or County Recorder of the county where the p; •• a .54 County Auditor
located on or before January 5 of the immediately succeeding calendar year. /novel
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the • it -•!^', County Recorder
where the property is located during the Melva(12)months before Mardi 31 nf6- eazwan-
See ' �.
reverse side for additional instructions and qualifications. y'�/ q// C;I ,
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vahre drool property as of Mortgage I Contract'indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
date,currant year assess ant date,amend year data of appliication legal or equitable owner?
/00 000 D Yes [I No
If no,what is his/her exact sham of interest? If owned with someone other than spouse,indicate with whom •
If name on record is different than that of applicant,'indicate betas. Is the properly in question:Annually Assessed
• ❑ Real Property ❑ Amwalty Assessed
Mobie Nome(IC 51.1-7)
Plan of m gee or contract selier�`-���`
ezif
Address of mortgagee or contact sailer(number and street ray,state,and ZIP code)
Name of assignee or other owner or holder of Mortgage • l/11�ft�
Address of assignee(mentor'and sheet a1 state,and ZIP code) • V)r\: -( -/Il 11 , . .
Drawer NO l//7w1
Does applicant own property in any U yes,what county? - What Taxing District? ('�' eduction
other in fndan�a? ❑yes ❑No U (, I
A person is not entitled to this deduction unless the person has a balance on the peon Card N 0. the county '
recorder's orrice Cmdudtng any home equity fine of aedt that is recorded in the county
COUNTYAUDITOR ' - -
Deduction approved in the amount of
•
20 20_ 20_ 20_ 20 20 20
Signature of CountyAudtn County Date(month,day.year)
•
I I We certify under the penalty of penury 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 aforementioned property on date application is filed.
Signature(owners fee name) �// Data(month,day,year)
X p.)0.-.--&X c • /CIE--
Full resident address of applicant(number and street city,state,and ZIP code)
tO4S w- s7 Rd. 6 `� ,14va3Z4dT. ..rAd fri7639
Person authored 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 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$10,000.