HomeMy WebLinkAboutMortgage_Cutsinger A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION .
1-1.1,114 State Farm 43709(R13f 10.75) ��g
JppIJ.
Prescribed by Department of Local Government Finance $:
INSTRUCTIONS:
To be hied in person or by marl - 1 i ore filed with:
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sough✓QU G 11 2u f
Must be filed orposbnarked with the County Auditor or County Recorder of the county where the property 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 Me with the County Auditor of Lii.r :cvy(011� nfy Recorder
where the property is located during the twelve(12)months before March 31 of each year the ded •..•
See reverse side for addAionalinstructions and qualifications. GIBSON COU FY AUDITOR .
Applicant lamer
or Ya buyer- restrictions on reverse side) •
anti
1,9 DiStiCi
Key minter agal description Rend number ber
/�/ ak _1 _ 05 . 30 ,2 _ oo . / 7 -0 A7 930i7 34 7
Assessed vathe o(re pto(ieny as of Mortgage r Contrail indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant We sole
ash date,aarera year
assessment date,anent year data of application legal or equilade owner?
9 7 xo Co ❑ yes ❑ No
If no,what is his/her exact share of interest? If owned with someone othstnan Txre•P,indicate with whom
If name on record is different than that of app&ant,indicate below: Is the property in question:Amway Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
LL c .
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage '
•
•Address of assignee(number and street ay,state,and ZIP code) ��-//y�� -
Dais app&ant own property in any If yes,what county? What Taxing Distil? Has tine dad= � To` -
tr�ana? ❑Yes ❑No arrant year??
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or .
recorder's office(including any home equity fine of credit that is recorded in the county recorder's offi !ce l 1 '- 3111
COUNTY AUDITOR "
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Patentor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner t contract buyer of the aforementioned property on date application is filed.
i Date(month,day,year)
i ut r ent
tt 'p (nu .. C. : ,state,AL.cod •I F3-1 - ' L_- /.c. � -N ' `I7 4, 7 0
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.yew)
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.