HomeMy WebLinkAboutMortgage_Blaize (3) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION 7711--��
� -�� State Prescribed Department meat 10-15)
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c- Presrnbed by Department of Local Government Franca
INSTRUCTIONS: File Ma D
'b be filed in person or by mail. h • U CD18
Filing Oates- 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought • V C
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year n
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county q❑u'
where the property is located during the hvehe(12)months before March 31 of each year the deduction is rg(g�0 COUNTY AUDITOR
See reverse side for additional instructions and qua .
or contract buyer- restrictions use ) •�>
T i g DistU-A� ai r Page n p
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Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the cep pliant the sole
assessment date,anent year assessment date,cement year date of application legal or equitable owner?
64 COO ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
/} Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /�////
Address of mortgagee or contract seller(nub and city,state,and ZIP code)
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Name of assignee or other ter of •
gea � /� / /D ��/�
Address of assignee(n elan city,state,and ZIP e)
Does applicant own property in any If yes,what county? Vital Taxing Disb ct? Has this deducton been requested If yes,state amount of deduction •
h a ❑Yes 0 No currerem year? ❑Yes 0 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 aedit 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 I 20
._
Signature of County Auditor Canty -
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I/We certify under the penalty of perjury that the above and foregoing information is true . _ ''''••••••. .. and
owner ••ntract buyer of the aforementioned property on date application is filed.
( Sig..-.ire(•,/r rill n�. l Cal-d NO.
Fullyesident address of-•• •(number and city,state,and ZIP code)
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Person authorized by duty executed Power of Attorney or 4 IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street ay,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.
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