HomeMy WebLinkAboutMortgage_Weyer �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION Y
'` Slate Film 43709(p73 Department o �g L tl"I�
� -� � Prescribed by Department of Local Government France
INSTRUCTIONS:
To be filed in person or by mail M,i filed with:
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought NOV 2 .U I�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ll•2).Mobile I Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of• 1.„.4;—ketro�: -• My Recorder
where the property is located during the twelve(12)months before March 31 of each year the
See reverse side for additional instructions and qualifications.
•tV.( IVAUDITOR
((owner or contract be -see restrictions on reverse side)
IN a)Ra err-- bin l� &)
T..: . �iyylpt Key numbed legal 'coon Record number Page number
!` d - / - 3G - 01019 - 00 / - 905 -odL1 AO12 klyd
• -.value of real property as of Mortgage 1 Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,parent year assessment date,anent year date of application legal or equitable owner?
Ita 5o 0 OD ❑ Yes ❑ No
if ro•what is his/her exact shale of interest? If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant indicate belve. Is the property in question:Annually Assessed
(Real Property ❑ Annually Assessed
• Moble Home(IC 6-1.1-7)
Name of mortgagee or cmuact seller
Address of mortgagee or Contract seer(number and street city,state,and ZIP code) -
Name of assignee or other owner or holder of mortgage /O '--1 - T . �_
l ` � , U
to O k
Adtlressyf assignee(number and ,and Zipcode� a I e /� U
((//esaPPp nty.r�s c-�- Dr-alvel- /'�'p. �1
Does applicant own property in any If yes,what county? What Taxing District? I ..�j 1 1 1•other Indiana? I •l./ l
in IMiana? ❑Yes ❑No ••.
• A person is not entitled to this deduction unless the person has a balance on the person Card IN 0 (/_./( .rty
recorder's office(including any home equity line of credit that is recorded in the county ro.,,,._. .'••- L-1! .J D•
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 l contact buyer of the aforementioned property on date application is filed.
kSignature( fulinam Date(month,day,year)
/Yl L
Fig oa r %Co„ 1;i)r state, cede) i.t/ 176 39 7
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street Sy,state,and ZIP code)
The penalties for perjury can indude imprisonment up to two and a half years and a fine not to exceed$10,000.