HomeMy WebLinkAboutMortgage_Speedy Q:r, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I
��1 FOR DEDUCTION FROM ASSESSED VALUATION
- �'4:= State Farm 43709(R13/10-15) - .
Presaibed by Department of Local Government Finance
INSTRUCTIONS: File Feva
be or AUG 8
Tb onfaedwur
F liing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pmpe is ❑ County Auditor ,
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the CountyAudttalQJfhA Recorder
where the property is located during the twelve(12)months before March 31 of each year the dedOttftbi _
See reverseside • additional instru•ions arnd qualifications. TY.AUDITOR •
Appfrcant(• .buyer- '-_� ,'•;.. -verse side) -
T- • y number/ '� din Rend number Page number
/ a6-( i/a- /d/ OO//€'.S D0Z? doi7 J.3:32
Assessed veins of mai properly as of ortgage/Contract indebtedness unpaid as of . Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cement year s d date,arrant year date of appr¢afi Q legal or equable owner?
l � 9 an, ❑ Yes ❑ 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 below ` Iss property in question:AnnaaulaliyAssessed
` ❑ M�Hom Assessed 1.1-7)
Name of mortgagee or contract sefer -57/3
Address of mortgagee or cataract semis(number and street cry,state,and ZIP code)
Name of assignee or other ourtner /aa/��of ;irt.ge /1 -' j4 , /Kill-
Address of assignee(number and sba ,state,and ZIPcocode/ ) - U
Does applicant own property In any If yes,what courtly? - what Taxing District? Has this deduction been requested If yes,state amount of deduction
other
bWan�a? ❑Yes ❑No aourm�nt yeear? ❑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(indudrng any home equity fine of audit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR '
Deduction approved in the amount of
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20 20 20 20_I 2°_ I 20 20
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Signature of CountyAmfdor C J,� e -
I/We certify under the penalty of perjury that the above and foregoing informal SPaall 11 1 tl 1 of Indiana and
owner/contract buyer of the aforementioned property on date application is filt
•
i. STinytaa.me)al leant( street city, and ZIP code)
is SOU N- u Nino Qinncu*' 94 ,4-1u-10
Person authorized by duly exeaiad Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authored person (number and street cry,slate,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.