HomeMy WebLinkAboutMortgage_Harper (6) : . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'-;:f l':- FOR DEDUCTION FROM ASSESSED VALUATION
. '- Sr 43709 p73
ikEt Presathe d by Deparment o f Lol ; vemert Fran ffSTRUCTlONS:
lb be filed in person or by mail. MOicut X48
Filing Dates: 1) Real Property.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/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county ^ corder
where the properly is located during the twelve(12)months before March 31 of each year the deduction 6 co UNTY AUDITOR
See reverse side for additional instructions and qualifications. -
t'%plrpraon6adbuyer-see on reverse
Taxing Distrcl ' Key l ! Record n Peg m
a / -/DA . 600. 2 2-Oa7 ' 17.3
Assessed value of real property as of 1 Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment data,current year date of application legal or equitable owner?
1-7d 9 COD ❑ Yes 0 No
If no,what is h51 her exact sham of interest? If owned with someone other than spouse.inckate with whom
If name on record is(Efferent than that of applicant i diicate below: the
Real Property question:Annually sses Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ��vv
( 9&2 rn gee
Address of mortgagee or contract seller(number and sleet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
-V)20_AA•in0 t —7/22L/59/,
Address of assignee(number and street,dty,state,and LP code) to
Does applicant own property in any If yes,what count - I••--•`°''' u''keen requested If yes,state amount of deduction
other county Yes- ❑No
in Indiana? ❑Yes ❑No (/�� f
A person is not entitled to this deduction unless th D f'111'C i' NO.. , , 4!`, .•ad indebtedness that is recorded in the county
recorder's office(unduding any home equity line o d is the basis for the deduction.
•
Deduction approved in the amount of: Card N O. I S 4 2;..J
20 20 20 - 20
Signature of County Auditor County Date(month,day,yew)
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 aforeme -• property on date application is filed.
.
Signature(• _ -) 7 Data(month,day,year)
Fug resid-' dress of app'•- nu city,state, •R LP code)
0 / 'Se 4 F __.e 1 __._ ,t4176
I'- uthodzed by duty executed Power of Attorney or by IC i 1.1-12-0.7 , Date(month,day,year)
Address of authorized person (number and street ctiy,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. .