HomeMy WebLinkAboutMortgage_Ward (2) �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
i` -."c/ State bed 43709 Department FILED Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. • f, 1 4 2017 Form Lied Kith
Rung Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sou gm.
Must be filed orposbnarked with the CountyAucrtor or County Recorder of the county t ore the property is. i-County Auditor
located on or before January 5 of the immediately succeeding calendar year. si
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the CoumtyAud'.. •■m,.- f7170' ❑ 'Recorder
where the properly is located during the twelve(12)months before March 31 of each year gm --^i i rte- So/rgtd_iDI TOP ' -
See reverse side for additional instructions� r_saa�nd�/rgqualifications. Cl BS• •
AppbcaSowner or W buyer-see
Waft 6 reverse side) -
Ta ttD' d Key number/legal description Rend number Page number
,,al CA 6-/9 -/8303- oao. 8v co? (0 dc'/ 3636
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 data,and year assesarem dale,anent year data of appficafion legal or equable owner?
lia000 ❑ yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than qvu n,indicate with wham
If name on record is different than that of applcant,indicate below: I Is the property In question:Annually Assessed
❑ Real Property 0 !nivaliyAssessed
— -Home(IC 6-1.1-7)
Name of mortgagee or setter --
rirc •
Address of mortgagee or contract seller(number and street city,state,and ZIP coda) .
contract
Drawer NO.... ...0i......
Name of assignee or other owner or holder of mortgage • /n
Card NO. 90.3.69
Address of assignee(number and street,cdy,state,and ZIP code) I /��(-/t
Does applicant own property in any If yes,what county? - What Taring District? ._..L/w,.a w4 �y�state amount of deduction
other county an properly fw
in Indiana? ❑Yes ❑No - I carers year? ❑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(rndudag any home equity fine of area t hat is recorded in the county recorder's 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 CountyAudlmr County Date(mordh,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is tole and coned and that the applicant is a resident of Indiana and
owner f contract buyer of the aforementioned property on date application is filed.
(" site_ V' 0(.4, � (month,day,tsar)
Full resid``ent` a��ddress of applicant(number and sheet,day,state,and ZIP code)
-y 4'30 N. t4 cn/;rw St finer 6,C40 C14 /A/ 4/76V 6
Person authorized by May executed Power of Atlbney or by IC 6-1.1-12-0.7 r Date(month,day,year)
.
Address of authored person (number and sheet 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.