HomeMy WebLinkAboutMortgage_Robison (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
fa FOR DEDUCTION FROM ASSESSED VALUATION Fri Countyggg ��1 1�Township Year
Ptete ribe 4by Department m nt o L!
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Prescribed by Department of Local Government Finance 7 Stl ,�
INSTRUCTIONS: File Mark
To be filed in person or by mail JAN 24 2018 Form filed with:
Filing Oates 1) Real Property Most be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Audrtor or County Recorder of the county where the property is ❑ 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 Audlk�i97
where the property is located dung the twelve(12)months before Mardi 31 of each j 68hf3 ulibhhYs sb ITO R
See reverse side for additional instructions and quaff:cations.
t(owner or contract buyer--Me restrictions on reverse side) ,
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T District Key number I legal description Read nuwpe` g number
a ._(p � ll - 13 - aoa , o00 .. X18- 0a7 x25 /p�`
value of mai as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of a application legal legal or equitable owner?
If no,what is his/her exact share of interest? If owned with someone oth than spouse, ❑ Yes ❑ No
,mdwate with whom
If name on record is drfferent than that of sputcam,indicate below. is the property in question:Annually Assessed
❑ Real Property ❑ Annualy Assessed
Mobge Home(IC 6-1.1-7)
Name of mortgagee or contact seller C/^��/1
Address of mortgagee or contract seder(number and street ZIP code)
Name of assignee or other owner or holder of mortgage
Address of nee(number and street city,state,ate(L/�P code
Does applicant(w/n i propenyyJin�any If yes,what county? /f/ What Taxing District? Has the deduction been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No curren n ❑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 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.
XSignature(owners fugnam�J.� / Date(month,day,year)
4"i-n L.ryj 121C -e 1 in,/
✓ Fug resident address of rant(nu ben and sheet iA state,and ZIP code)
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Person authorized by duly executed Power of Abofney 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 S10,000. •