HomeMy WebLinkAboutMortgage_Davis (4) d/ q STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
/e��. FOR DEDUCTION FROM ASSESSED VALUATION
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:' Prescribed by Department of Local Government Finance I_�
INSTRUCTIONS: 11=! `
To be filed in person or by mail. Form feed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sougpA,
Must be filed or postmarked with the County Auditor or County Recorder of the county where th erty 6 20 17 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. - ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor o the county
where the property is located during the hvelve(12)months before March 31 of each year the de.1 c.on is s.ii.. d
See reverse side for additional instructions and qualifications. 1 9m11h
Applicant(owner or contract buyer-see restrictions on reverse side) GIDSON COtAN 1 Y AUDITOR
Davis, Tim I
Taxing District Key number/legal description Record number Pang " bere
Ft. Branch 26-19-19-203-001.256-026/Indian Hill Lt 16 c,^( /L 4T3
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
113700 0 50875 ❑ 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 ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
GVC Mortgage, Inc.
Address of mortgagee or contract seller(number and street.city.state,'and ZIP code)
One Plaza Dr., Suite 3, Pendleton
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city 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
other county on property for
in Indiana? Yes ❑No current year? ❑
ID 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 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 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 I contract bu er of the aforementioned property on date application is filed.
(—)7:—P. Signaature(owne(s I II n e) Date(month,?ay,year)
WI resident address of applicant(number and street a st and ZIP y f (eL / 7
/Gh4—_F 79:59 f �r ��
Person authorized by duly executed Power of ttomey 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)