HomeMy WebLinkAboutMortgage_Kavanagh STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County 'Township Year
N.
'fi' = FOR DEDUCTION FROM ASSESSED VALUATION ` `N
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Stets Fore 43709(p73 Department o �.� .�
Prescribed by Departrnertt of Local Government Finance �J 7
INSTRUCTIONS: A. /
To be filed in person or by mail Font,sled whh: V/W
Fthng Dates 1) Real Property.Must be completed and dated in the calendar year for vehich the deduction is sought g�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is JUL L%ouoty Auditor
located on or before January 5 of the inrmediatey succeeding calendar year. 0 corder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county/j
where the property is located during the twelve(12)months before March 31 of each year the deduction is so
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
T�-A rt(owner ^# see,esbicdorrs1on reverse side)side) /� �� /� j�
. g DV.-'•.+`:..!• I f1 11.1 description r �' l-ll Y '"L� ®. T _ Record number Page number
wa 9^—c �V� a C>-0LA -a3— 300 - intZ3 . . . 3
Assessed value of real property Ss d Mortgage I Contract indebtedness unpaid as of Mortgage/ • e-• .ebtedndss unpaid as of Is the apps ant the sole
assessment date,eared year assessment date,current year date �?�Y�1"i"�+ Gft7 legal or equitable owner?
If no,what is his I her exact share of interest? If owned with someone other thbn� with whom Yes ❑ No
If name on record is different than that of applicant,indicate belay. Is the property in question:Annually Assessed
❑ Real Property ❑ Ann Assessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contact seller
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ce_d_e ca Q C y t--nth I- V_- ____, • . .
Address of mortgagee or contrail seller(number and street city,slate,and ZIP code)
Name of nee or other owner or holder of mortgage
VTSw a3-1 - 11 l (0 4
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Address of assignee(number end street city 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
in Indiana? ❑Yes ❑No aaiirren�year? ❑Yes ❑No
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A person is not entitled to this deduction unless the person has a balance on the person's m --- — ounty
recorder's office(mdudirg any home equity line of credit that is recorded in the county recoi
COUNTY AUDITOR (A �;,,I� ��//J(�
Deduction approved in the amount of y IAn 'y \ r`o
20 20 20 20 lll..JJJM( �"3 -
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Signature of County Auditor County •
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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 date application is fled.
Signature(.4005 fut..„. .e) '� Date(month.day,year)
u6 resident address of applicant(number and street,dry,state,and ZIP code) ,/ /'
X 5,P -o ,✓ Zz5 f-/ /°)A4+,0 a SA) 14166
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 sheet city,slate,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.