HomeMy WebLinkAboutMortgage_Stull a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County t: tea nty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Sfax Forth 43709(R73/10.75)
atb
Presed by Department of Local Government Finance FILE
A
INSTRUCTIONS: File Mark
lb be filed in person or by mail. JUN 1 , 4i n,with:
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 properly". ❑ •un •udito' pb
located on or before January 5 of the immediately succeeding calendar year. f , -:/'RmL1 t ounty Reco •-—
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Couny Auditor• •- •Rr
where the property is located during the twelve(12)months before March 31 of each year the•,• ,rr:Neff-
': ..See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side
I r I ( I Av re ,0_nd ,co QC'
Taring i ct Key number/legal desaiptim I Record number Page number
vahre of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,anent year date of application legal or equitable owner?
64A Li Lk o(-)0 ❑ Yes ❑ No
it no what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant,indicate belay Is the in question:Annually Assessed '.
Is
❑ Annually Assessed
- �'• I �.t !\l • Mobile Home(IC 6-1.1-7)
Name of mortgagee
Y.}�4 , c.27 �•lJ� `t_�-`.n Y-
Address of mort'mortgagee.` or contract seller(number and street dty,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dry,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other IbWiry ❑Yes ❑No current yeaea? ❑Yes No
A person is not eutilkd to this deduct on 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 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 - Date(month,day,year)
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.
Si Se Date G„w.dr,day,ye
r address of (number and street city,slate,and ZIP code)
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 dqi 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.