HomeMy WebLinkAboutMortgage_Fox (4) 1e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e FOR DEDUCTION FROM ASSESSED VALUATION ��
�'-� State Form 437 (R13!10.15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mall. AUG 16 2017 Ron flied With:
Fling 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 Courtly Recorder of the county w the property' t,7 County Auditor .
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Properly.Must file with the County yr minty Recorder
where the property is faceted during the twelve(12)months before March 31 of eafaiikafabb Glifithliffit*hsQvTO
See reverse side for additional instructions and qualifications.
Applicant( buyer-see n�a cstde)
1V1�— O t,0 /ent
r ishid/y °�, �11j Key number/l csal description h /� Read number Page number
ilk Assesged value or red property e CJ of I `motg CO--I Contract indebtedness a -nd unpaid as--(Do . Contract indebtedness c70/7
Is the aid tyre? le
assessment dab,current year assessment date,aurent date of application legal or equdable owner?
❑ Yes ❑ No
If no,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 tan that of applicant,indicate below. Is the property in question:Annually Assessed
. ❑ Real Property ❑ Anrlite I4ome(C 6
NbWle one(IC 61.1-T)
Nauru of mortgagee mob!seller I tr
Address of mortgagee or contact seller(number and street,city,state, ZIP code)
Name of assignee or other owner or holder of mortgage ' 1-� —
Address of assignee(number and street my,state,and ZIP code) - a° 1 — 24 q
1 �{
y1 (-
•Does applicant own properly in any If yes,what county? - what Tazbxg District? l_0.t`Y f. , O a- S \C J c r\ 1 t )damn
other county
in miliaria? Thies ❑No - i
A person is not entIled to this deduction unless the person has a balance on the person` '3 O 1 U C v 'he county
recorder's office(including any home equity fine of credit that is recorded in the county n
COUNTY AUDITO •
Deduction approved in the amount of:
20 20 20 20_ 20_ 20 20_
•Signature of yy•k je County Date( .
I I We certify under the penalty of perjury that the ab Fagoing information is true and correct and that the applicant is a resident of Indiana and
otter/contract buyer of the aforementioned property on date application is filed.
rice(ryes hag Date(month,day:year)
C'� .) r B -Ili -17
Full residerd address of appfwarf.(number and street city,state,and ZIP code)
,rsciirrOti 5. I'r ■ace Si- {2r;vi cdon 1-0 Yq-6FO
authorized by duly executed Power of Attorney or by IC 61.1-12.03 Date(month,day,year)
Address of auttorized person (number and street,why state,and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed 510.000.
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