HomeMy WebLinkAboutMortgage_Banet (3) r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
rt--: '
; ,;;; FOR DEDUCTION FROM ASSESSED VALUATION
.,.._._ PlatsForedby Department nto IFI
�-- Prescribed by DepartmleM of Local Government Finance 1 EI:s
INSTRUCT/ONS:
To be filed in person or by mait filed witA;
Filing Dates: 1) Real Properly Must be completed and dated m the calendar year far which the deduction is sought MAR 2 0
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 0 County Auditor
located on or before January 5 of the immediately suooeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Pro A r W ^•nty Recorder
Properly:Must file with the County Auditor o7, : vim, �!'ni�
where the property is located during the twelve(12)months before March 31 of each year the d� a ra
See reverse side for add-' at instructions and gquuafifications. (Wan •II TYAUDITOR
Appbcant(owner or -see C. side)
Taxing District Key nu legal description rt Record number Page number
C1-u-ta-ion( 'ODD .6q 1 -oa5
Assessed value of real property as of Mortgage/Contact'indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cement year assessment date,amen year date of a D z\ legal or equitable Groner?
If no.what is his I her exact share of interest? If owned with someone of er than ❑ Yes ❑ No
spouse,indicate with whom
If name on retard is efferent than that of applicant,indicate belay. Is the property in question:Annually Assessed
❑ Real Property ❑ Annuagy Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller a q u £0
Address of mortgagee or contract seller(number and street dry,state,and ZfP code) ._
Name of assignee or other owner or holder of mortgage ���
Drawer NO
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,what county? what Taxing Distnd? Hash Card N O. /o r
other on pi
in Indiana? Yes ❑No , CURE
A person is not entitled to this deduction unless the person has a balance on the person's coo mty•recorder's office(including any home equity line of credit that is recorded in the county recomer a urr .. ____._._.-
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 data application is filed. ;y,) Q
91gr�Wrr tub nom ) ��'v'+2C/!/ i i Date RnaU+-da(�3-30-1 U
Fun(\r/e anJ� of app'kant(ou rand sfr92t,cab; and ZIP code) (-� t �— (a 0
Person gent
by duyN executed d Power of Attorney or by IC 6-1.1-12-0.7 \L@,t"•t/, Date(month,day,year) •
Address of authorized person (number and street city,state,and ZIP code) - •
s`_
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .