HomeMy WebLinkAboutMortgage_Peterson s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tic FOR DEDUCTION FROM ASSESSED VALUATION gT1U1
r` Plats 43709(par m nt o FILE
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�— State Prescribed F by Department of Local Government Finance
INSTRUCTIONS: e ark
To o Dates: Real by mail.
Properly:Must be completed and dated in the calendar year for which the deduction is sough/C T 13 20 7orm filed""":
Must be filed or postinarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the umnediately succeeding calendar year. i County
2) Mobile/Manufactured Homes not assessed as Real Properly:Must We with the CoundyAuditor o , ,, jrfmj Recorder
where the property is boded doing the twelve(12)months before March 31 of each year g r•:5� 1.,4
See reverse side for additional instructions and qualifications. + � AUDITOR
nt(owner ar conaact buyer see stricdans on reverse side) .
•
T gistrict Key number/legal description Rend nu
�neeti �<,0 ot L, -//-/S- zoo -oo ,3. 909 -047 (0
Assessed value of real p as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,anent year date of application // legal or equitable owner?
If no,what is his/her exact share of interest? If owned with someone other rttfian spouse.indicate with whom ❑ Yes ❑ No
if name on record is afferent than that of applicant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
tvbblIe Home(IC 6-1.1-7)
Name of mortgagee or contract seller � ,�,,/Z /!. ) ,
``/�?i atcd �lt_+� 1,11 C-c'
Address of mortgagee or contract tuber and abeet,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage y) _jTrn SU 0 A•:Masi e D D
Address of assignee(number and sheet city,state,and ZI C (��.-roll+ M tom` L.
Does applicant own property in any If yes,what county I q- 1 1 G U in requested If yes,state amount of deduction
other county a 1
in Indiana? ❑Yes El No es, 0 N
A person is not entitled to this deduction unless the person has a balance on the persons nthryayc,,, act indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that 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 County Auditor County • Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and corned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(• �.. name Date(month,day,year)
k
resident address of app!!�• t(number and sheet city,state,and ZIP code)
7 Li 9 rQ .Vo - x a-nc, immix--e . 2 `i 9WY a
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
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.