HomeMy WebLinkAboutMortgage_Hughes (3) ,pl STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
ct
- Presorted by Department of Local Government Finance
INSTRUCTIONS: - F I ED
To be filed in person or by mail. For,filed wit
Filing 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 where the propeh9 g ' 4 2M7 7 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 of the s+ ,
where the property is located during the twelve(12)months before March 31 of each year the deduction" -rrrr=:/•m7�,
See reverse side for additional instructions and qualifications. GIRR(lN ('.(TIINTV AIIOIT(1R
Applicant(o contract buyer-see restrictions on rave sliidde),v
Taxing Distri Ivey number!I�description 1—I 4 Record n Page number
c26 - , 3-13 -4oa- 4 fl- OD 1 503:
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage I Con ttaQ indebtedness unpaid as of Is the applicant the sole
•
acrosvrent date,aurerd year assessment date,current ear date of
y application
legal or equitable owner?
/QS.6C,)7�7, ❑ 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
Address of mortgagee contract sale (number and abeet,city,state,and 2/P code) - �-4-11buuj/-71. It//1�.��oL
Name of assignee or other owner or holder of mortgage o
Address of assignee(numb&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 or deduction
other on property for
in Indiana? Yes ❑No current 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 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/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
/contract buyer of the aforementioned property on date application is filed.
eer
re e(ownnler's full name) Dam(pz nthE aar))r i e fxadt( um aorta,and ZIPcod /l QrJ
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 ( I Date(month,day,yea)
Address of authorized person (number and street dty,state,and ZIP code) l/
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.