HomeMy WebLinkAboutMortgage_Moore !S STATEMENT OF MORTGAGE OR CONTRACT�lQ F D EIS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATIm1 Q�J
State Form (R73!10.15) gg .. ,..J
Presabed by Department of Local Government Finance
INSTRUCTIONS: OCT 2 3 2011 File Mark
To be filed in person or by mail. Fo filed with:
Filing Oates 1) Real Property Must be completed and dated in the calendar year for • the d-• ..a.r " ght
Must be filed or postmarked with the County Auditor or County •• • [j, . - =. ;j. the property is only Auditor
located on or before January 5 of the immediately succeeding,aip... rrf
2) Mobile/Manufactured Homes not assessed as Real Proper4$fll '•�71 : r umyAbailoYathe county 111 County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifi cations.
Applicant(owner or ran r� on .L C,G / C
ah2Za
T Dstricl Key number/legal description Rend number Page ber
//.!/y1 11? JOIC. Z - Q-�R- io 3 oo . y 87 - Da 8" r�.O-/ 7 `4V 3 )
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,arrant year assessment date,current year date of appliatlon legal or equitab:e owner?
/ /O7 ❑ Yes 0 N
If no,what is his l her exact share of interest? If owned with someone other than spouse,indicate with whom
If nacre on remrd is efferent than that of apprant,indicate below: Is the property in question:Annually Assessed
meal Property ❑ Annually Assessed
Tci {� Mobile Hone(1C 6-1.1-7)
Name of mortgagee r se/ C �� Mme.
Address of mortgagee or contract seller(number and street city,state,and ZIP code) S n
'\ K MbOW
Name of assignee or other owner or holder of mortgage 020/ / / I! '//7
Address of assignee(number and sheet city,state,and ZIP code) 7 ^ l�t..l 3
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,sew.�..__ ion
other county on property for
in Indiana? Yes ❑No aurent year? ❑
❑ Yes- ❑No •
A person is not entitled 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 any home equity line of credit that is recorded in the county recorders 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 coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
�namre(v I'�—.+..-n-.�- ri�,.:r•� Date(month,day,Yew
Full resident address of applicant(number and street,city,state.and ZIP code)
/x7/05 5. �s �p,J Ave- Oti .gyp. , I� 2172
Person authorized by duly executed f 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 Iwo and a half years and a fine not to exceed$10,000.