HomeMy WebLinkAboutMortgage_Hughen ,t: ;�' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1114) FOR DEDUCTION FROM ASSESSED VALUATION 5v --' gpp �1q�
Suter the 43709 D(pa t Department o F I ® J�/
Prescribed by Departnrent of Local Government Finance jj���J ��JJ
INSTRUCTIONS: . DEC 1 1 2017 Mark
Tb be filed in person or by mail.
Form filed with:
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 th- •-•perry i_ S' County Auditor
boated on or before January 5 of the immediately succeeding calendar year. 'IliPr .
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the Coq r•- ,•rr!. a ❑ County Recorder
where the property is located during the twelve(12)months before March 31 of each --• c�J�f Jre.Y k g•�, PUDITOR
See reverse side for additional instructions and qualifications.
App7(Ai t. =tract buyer-Sekeyll!f
Taxing Distal Key'comber I legs description Rand number Page number
��- /-o/- M-00 • /Ga.dal 010/? .076-y
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment dare,current year assessment date,amem year date of a pl it'd legal or equitable owner?
/O fav, ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,inthcate with whom
If name on record is different than that of appgrant,indicate below: Is property in question:Annually Assessed
)(Real Property ❑ Annum yAssessed
Nbblle Home(IC 6-11-7)
Name of mortgagee or contract seller/
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Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,city,state,and ZIP code)
- Does applicant own property in any If yes,what county? W CI _ `� ` `�
other county yes,state amount of deduction
in Indiana? Elves 0 N CndCL'c -t \'kLu Zvi
• A person is not entitled to this deduction unless the person has c� I :that is recorded in the county
recorder's office(including any home equity fine of credit that is ( `.r4p� ;} . 9rU.r l-r - '- he deduction.
Deduction approved in the amount of
Cflc3c -4' I144 o .o6
l
20 20 20 20
I
r
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 1••ntract buyer of remen' ed property on date application is filed.
Signawre �{'-is an i Date(month,day,year)
y
Full -'•? a...r•- t(num an 4 state,and ZIP ,1/I/hO( /
/ /,5� � l''i� /. - \a 4 70
Person authorized by duty executed Paver of or by IC 6-1.1-12-0. 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 10 000. -
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