HomeMy WebLinkAboutMortgage_Matheis ,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
''t' FOR DEDUCTION FROM ASSESSED VALUATION
cdState Forth 43709(R13/10-15) FIT
Prescribed by Department of Local Government Finance ,,_
INSTRUCTIONS: _ File Mark
To be filed in person or by mail. MAR R ForuihOled with:
Filing Dates: 1) Real Properly.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 I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the boiritly t, ��H Recorder
whem the property is located during the twelve(12)months before March 31 of each year the duets ught" r
See reverse side for additional instructions and qualifications. v {AUDI TOR
Applicant(owng see verse 'd .� /� 7)10R—OR Q//
Taxing District mOer/l,. • 'LV,4.— coo. (0 Record I r aott
Assessed value of real property as of 1 Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable avner?
❑ Yes ❑ No
0 no,what is his t her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record S different than that of applicant,indicate bebw. Is the property in question:Annually Assessed
❑'Real lluperty ❑ AnnualyAsssessed
• Mobile Flom(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and sheet ay,state,and ZIP code) -
Name of assignee or other owner or holder of mortgage L Li 6 T ACA(3
Address of assignee(number and sheet city-state,and ZIP C I MAT/4 E
Does applicant awn property in any If yes,what county? I B —Q I n O requested If yes,state amount of deduction
other county ❑Yes 0 N B 1�-'�I . 0 N
A person is not entitled to this deduction unless the pe :indebtedness that is recopied in the county
recorder's office(utdudug any home equity line of ore 3-c\-( s' the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
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 coned and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed. j(month,
Signature(� )�� ; Ud cad
Full resident address of }r I
applam(number and street cdl:state,and ZIP code)
/O'-1 E. Vwt 51. C+. genic), `17(o alt
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 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.