HomeMy WebLinkAboutMortgage_Christy STATEMENT OF MORTGAGE OR CONTRACT INDritn� {E nty Twmship Year
ROM ASSESSED VALUATION .•J
Presorted by Depa rtment of Local Government Finance
INSTRUCTIONS: OCT 16 2017 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which tltlm-�•ed .r•.•is :--•
Must be filed or postmarked with the County Auditor or County Recorder of..d>i::r tu'.u'., ap e property is ❑ County Auditor
located on or before January 5 of the immediately succeeding tale • -� t C ( )TY D ITO R
2) Mobile/Manufactured Homes not assessed as Real Property:Mu ' ;-�i t1re Co�nly Au of the county El County Recorder
where the property is located during the Melve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or see on rse side).
Taxing / �/��i ti n '�` Record number Page number
■ �feta,�a/\ ) d /0-1p-iq -in 3 coy 0 a5 on) 6 c O/7 4/34' 9
value of real property as of Mortgage!Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment data,aurent year assessment date,current year date of application legal or equitable owner?
J 8-.-Ci/ ❑ Yes ❑ No
if no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
if name on record is different than that of applicant,indicate below: is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
40-3_ Montle Horne(IC 6-1.1-7)
Name of mortgagee or contract seller j/ e - e
3 /
Address of mortgagee or contrail seller(number and street city,state.and ZIP code) l.,- � J
p , ACG
v r
Name of assignee or other owner or holder of mortgage ,Zr, ' (1 J.
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Address of assignee(number and street dfy,state,and ZIP code) f G {U ( a
Does applicant own property in any It yes,what county? What Taxing District? Has this deduction w..... .m of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? Li Yes- ❑No l
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is ree...rded 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 correct and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Signature e0(oow�ner's Ml name) Date(month,day,year)
R
Fua rim ad,�or apt number city,state,and LP e)
n 913-c ,� n - - 3014-r h -j j L-1-1 (2 Lj-5
Person authored by duly executed ow&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 LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.