Mortgage_Ramsey (3) STATEMENT OF MORTGAGE OR CONTRACT IND S'i & w Township Year
`}z- FOR DEDUCTION FROM ASSESSED VALUATION ��
ci Stale Porte 43709(R13/70.15) I ?, i•, NW: . t,Prescribed by Department of Local Government Finance APR 11 2018
File Mark
INSTRUCTIONS: r,
°•
To be filed in person or by mail. MAR '.•. ,7a{G% it
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which y[�pded ' . ngJl�
Must be filed or postmarked with the County Auditor or County Recorder of a property is 0 County - •itor
located on or before January 5 of the immediately succeeding care BN COUNTY AUDITOR ill, =R -c—.j-
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of u::•u��,,4= •='t f^r-I ?"�• corder
where the property is located during the twelve(12)months before March 31 of each year the.:. '-iI r� - • - - -
See reverse side for additional instructions and qualifications.
Applicant(ox'nFro{contract buyer-sea resnirlions P9 reverse skecit,
Taxing District Ket,n I Word esoipfgn ° \ Record number Page number
—$— O t I o-t -(aa- 'S . 6b3--ea( AD( I% 4 t 3o
slue of property as Mortgage/Contract indebtedness unpaid-as a of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment dam, year assessment date,anent year data of application legal or equitable owner?
,..), ptD (D pores ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,inchoate with whore
If name on record is different than that of applicant indicate below I Is the property in question:Annually Assessed
t_Geal Ruperty ❑ Annually Assessed
- p '/� Mobile Home(IC 6-1A-7)
Name of mo •-.., o contract seller t-7, �t 5j. /1 3�c /,
of o(J J� ao► g
Address of • • .!!or contract seller(number am/street city,stem. Drawer NO
Name of assignee or other owner or holder of mortgage 1030
Card NO
Address of assignee(number and street City,state,and ZIP code) ON if
Does applicant own property in any If yes.what county? What Taxing D District? Has this deduction been requested If yes,state amount of deduction
other countywoperty Tqr
in Indiana? eS �`}/'�',',0 rrdtyeaR es• 0 N
A person is not ed to this deduction unless the person has a balance on the person's mortgage or tract 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 • Data(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 I contract buyer of the aforementioned property on date application is filed.
Signature(wormer}fu6 ) / Dam(month,day,fear)
�y r }Vi�.Cssd_ t rum and City,state,and VP c�yi ^ n
? 9 y(4 5
son authorized by 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 penury can include imprisonment up to two and a haff years and a fine not to exceed 310,000.