HomeMy WebLinkAboutMortgage_Meece (2) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
14-�.�g-'';FF FOR DEDUCTION FROM ASSESSED VALUATION
�- State 43709(R13
• Presorted by Department o f
Local Government Finance
INSTRUCTIONS:To be filed in person or by mail. D Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
SC 2n,,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Cauoty 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 cou
where the properly is located during the twelve(12)months before March 31 of each year the deduS3B@
See reverse side for additional instructions and qualifications. °UAn-L
T �t - !legal descrip0on// � Record 9umber Page n r
-0 eh-) /3 zz$c - 600. � VJ- 66 . , i . r5 at S_
Assessed vahre of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of applicot n legal or equitable owner?
❑ Yes ❑ No
tf no,what is its/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is di ferent than that of applicant,indicate below Is property in question:Annually Assessed
Real Property ❑ AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract setle� 1�� t ��
Address of mortgagee a r
contract seller(number and street city,state,and ZIP code)
Name of assignee or other comer or holder ot
a�v
Address of assignee(number and -••- • , -'e,and ZIP aide) /�
Does applicant awn property in any N yes,what county? What Taxing District? ,/1/ L . 3 eg r /s ductiom
other county CC.!! �/
in Indiana? ❑Yes El No
A person is not entitled to this deduction unless the person has a balance on the pc he county
recorders office(indudmg any home equity line of credit that is recorded in the cot /79gkc .� mS�A E L E
COUNTY AU C..G/
Deduction approved in the amount of SNA eat
20 20 20 20_ r, POM d/aul�
Signature of County Auditor C /!`�-��-'�f ODD`
I I informs certify under the penalty of perjury that the above and foregoing infoa # 7s LXJL) t"- fdiana and
owner I contract buyer of the aforementioned property on date application is fib
( Signature MD name)
Full resident address of applicant(number and street,city,state,and ZIP code)
3361 Soual sate Ea( S7 �AKlo-vc(( ;ry svr . row
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 ay,state,and ZIP code)
The penalties for perjury can include imprisonment up to Mo and a half years and a fine not to exceed S10,000.