HomeMy WebLinkAboutMortgage_Farmer (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS • Township Year
�_ FOR DEDUCTION FROM ASSESSED VALUATION
Prate FOre 43709(R13 m 10-15)
o �� , -
�-- Prescribed by Departrrerrt of Local Goverment Finance 1
To be filed in person or by mail. ‘40V 2 1 20}1 File Maw with:
Ring Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county - - the r,..-,r!• is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year -II"V»y„1�1�tp�� R
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coq �'Ir. , i$16 ObblffyT -.-. ❑ County Recorder
where the properly is located during the twelve(12)months before Mardi 31 of=-. a s - -. '. is sought
See reverse side for additional instructions and qualifications.
t(owner or confr .buy�erj-see re on reverse )
I11 r /�/ 7 i1 y ��IfrJ2,an /
T s'fnd nu / de5[xiptioal Record number Page number
iz;-Ca - ,363ooQ � 6, OaFS btoll Sa32-
Assessed value of property as of I Mortgage 1 Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year I assessment date,current year date of application legal or equitable owner?
J010061 ❑ Yes ❑ No
If rio,what is his!her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is di ferent than that of applicant,indicate below Is the properly in question:Annually Assessed
❑Real Property ❑ Annually Assessed
•�°, fin rf /rte) M3blle Bare(IC 6-1.1-7)
Name of mortgagee or contract sever( / lC.�i'/�'^-�r+i ./ / l�(���� �) . ,
Address of mortgagee or contract seller(number and street,city,state.and ZIP code) -
Name of assignee or other owner or holder of mortgage p
/ all 1� _563
Ate
Address of assignee(number and street,oty,state,and ZIP code) u \.\l w( •
Does county pp ant own property in any If yes,what county? What Taxing District? M. �`� dud ion
in person is ❑Yes ❑No C-
A person is rrot entitled to dUs deduction unless the person has a balance on the persc 1e county
recorder's office(including any home equity line of credit that is recorded in the county
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.
SigreOmre( .fuBname) Date(••wdh,tray,Year)
1C a F resident dress of appfrant(number and sheet,city,state,and ZIP code)
k e/07 w G7r,ida(e- F24. /? ,4 'e/on 1N, Y-17€> to
Person authorized by duly executed Power 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 ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.