HomeMy WebLinkAboutMortgage_Whitledge s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
fFOR DEDUCTION FROM ASSESSED VALUATION
�'� State Ran 43709
Department M
Prescribed by DepaMrent of Local Government Finance
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INSTRUCTIONS: ■--1
To be filed in person or by mail 'Form ni tt c(thi
Filing Oates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought NQV 44--,,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is cl-J unty Auditor
located on or before January 5 of the immediately succeeding calendar year.
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2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor Dube cou 0 County Recorder
where t h e p r o p e r t y i s l o c a t e d d u r i n g the t w e l v e(12)m o n t h s before M a r c h 31 of e a c h y e a r t h e ded ie'
See reverse side for additional instructions and
qualifications. C p /^rt ,4(
Appfran . potray -searesomo side) , 'CU
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T/ ry C mber/lei ' -
number
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_ of of Mortgage/Contract indebtedness unpaid as of Mortgage l Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of appl' legal or equitable omen
�Oy ❑ Yes ❑ No
If no.what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is dflerent than that of applicant indicate below `hs property in question:Annually Assessed
Q Real Property ❑ Annually Assessed
/// --_ Mobile Home(IC 6-11-7)
Name of mortgagee or=tad seller 7, e `���
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
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Name of assignee or other owner or holder of _ -,
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Address of assignee(number and street dty,state, ..code)
Does applicant own property in any If yes,what county? What Taring District? Has this deduction been requested If yes,state amount of deduction
Mara? ❑Yes ❑No current�R ❑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:
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20_ 20 20 20 20_ -_ 20 _ _I_ 20
Signature of County Auditor -
County - n,l�-lo� —
I/We certify under the penalty of perjury that the above and foregoing information is but o`/--tl Y�1 J /
owner I contract buyer of the aforementioned property on date application is filed. Drawer N O,,,., `
'9atu (owners run name)
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is, � ='v ent address of bcant(n tier and street city.date.and ZIP code)
iso . en-r�.,ta>,d Pr On u - -TA/ Is
Person authorized by duly executed Power of Attorney or by IC 6-1.142-0.7 Date(month,day,year)
Address of authorized person (number and street city,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. - ..