HomeMy WebLinkAboutMortgage_Reavis r: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State From 437th(part lots) ' r
Prescnbed by Department of Local Government Finance :� �.
INSTRUCTIONS: '' ' 1
To be filed in person or by mad. A(/G From f led with:
Ring Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction Is sought 17 r.,7
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prop/- is U County Auditor :
located on or before January 5 of the immediately succeeding calendar year. I'1';',13 • coDnty Recorder
2) Mobile/Manufachaed Homes not assessed as Real Property.Must file with the County Auettg•
where the property is located during the twelve(12)months before March 31 of each :'' ' �Ir?l/j:i -
yearthe.-.u�,. Ls'�.
See reverse side additional rustnr.'•- -and qualifications. t Y
Alm,-,._•
App5ram(. ., .•..,.buyer-see , on reverse side), •"/Y.
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Page number
Assessed value ofmai properly as of Mortgage/Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dais,cement year assessment date,amend year data of application
•-5- U,(� legal or equitable owner?❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spn,se,indicate with whom
If name on record is dement than that of applicant indicate below Is property In question:Annuagy Assessed
Real Property ❑ Annually Assessed
/ - Nome(IC 6-1.1-7)•Marro of mortgagee or contract seller
Address of mortgagee or=tad setter(rumrberand sf �)
•
Name of assignee or other holder of 0 ��1 /
•
7 7 o?GJ 3/-0 - /O , 7of/C✓
Address of assignee(number a d ty,state,and ZIP code) .
Does applicant own property in any If yes,what county? . What Taxing District? Has this deduction been requested If yes,state amount of deduction
on in Ind? ❑Yes ❑No aame�mtyeaR ❑Yes ❑No
A person is not eMrEed 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(including am,horns cone.a.—.a-----...----recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR " - '
Deduai
n Drawer NO............
20 20 20
Signalm County Date(mouth,day.year) -
/Y'• •.
Card NO. .... ..
•
lilt', ..
'mooing information is true and coned and that the applicant is a resident of Indiana and
+; ow turners and name;✓ - , -..�.'"application is Tied. Date(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code)
- 2 1 0 t 5 6X 8 S 7 1 v 9 T r a d i i'ila g et 1 &3 7
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yea) _
Address of authored person (number and smeet dy,slate,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.
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