HomeMy WebLinkAboutMortgage_Grabert STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
` 43709 10-15)
Department FILED
�-- State roan by Department of Local Government Finance
INSTRUCTIONS: • File Mark
lb be filed in person or by mail DEC 1 9 21 tnn filed whh:
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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. �,!
2) Mobile/Manufactured Homes not assessed as Real Properly Must file with The County Auditor of U �uMy Recorder
where the property is located during the twelve(12)months before Mardi 31 death year fbeSelbit govotitv AUDI I OK
See reverse side for additional instructions arrdqualifications. •
...�• orbuyer/ ryon reverse )
e -'La ? yoi7
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,aumd y9ary r, assessment date,current year data of appli ation legal or equitable owner?
(/J-- %,--"�f ICCO ❑ Yes ❑ No
If no,what is his 1 her exact share of edgiest? If armed with someone other than spouse,intricate with whom
If name on record is different than that of appti an4 indicate below. Is th property in question:Annually Assessed
Real Property ❑ Annually Assessed
Montle Home pct 61.1-7)
Name of mortgagee or contract Seller
anC1 tea
Address of mortgagee or contract seller(number(and street,city, ter and ZIP code)
Name of assig ;,4.r -r own- or holder of ..it 4 e _
fl ' Ft ' ; .// , .4 !r Vii_ -s .
Address of assignee S mbar and street city,state,and ZIP code) C ` 3
• °7 AC er NO °`" 1 T
Does applicant own property in any If yes,what county? What Taxing District? Ha
other county ❑Yes 0 N cu
• A person is not entitled to this deduction unless the person has a balance on the person's n Card NO. s---L.rh my
recorder's office(including any home equity line of credit that is recorded in the county recc
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20_
Signature of County Auditor County - Date(month,day,year)
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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/contract buyer of the aforementioned property on date application is filed.
S' re(ovners fu8 tjne) Date(month,day,year)
� F rsidemt�address ofna'pplicant(number and street,city,state,and ZIP code)
33it J1 MyrY Rd4,Lrlf Dr. Pr:n(cf.rs IN '4 7670
Person authorized by duly exeWted Power of Attorney or WIC 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$10,000.
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