HomeMy WebLinkAboutMortgage_Minnis (10) STATEMENT OF MORTGE OR CONTRACT INDEBTEDNESS Cou Townshi!!1) partm I D
Prescribed by Department of Local Government Finance '�pp'�'� J
INSTRUCTIONS: JULef `/MR
To be filed in person or by mail. Form filed 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 CountyAudrtor or County Recorder of the county whem the property is�(/1��,, ! ditor
located on or before January 5 of the immediately succeeding calendar year. h+� "- gists ..t-y Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must fife with the County Auditor oftth&MIN CO J Y AUDITOR
whem the property is located during the twelve(12)months before Mardi 31 of each year the deduction Ls sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) \ \
pecng District Key number I legal description - Record number Page number
Y.Cr ate- \\ - LoGIS oaf I g 08?6
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedn.ess unpaid as of Is the applicant the sole
assessment dale,anent year assessment dae,current year date of application m legal or equitable owner?
S 1'an ��� ❑ yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is dfferent than that of applicant,indicate below: Is the property in question Annually Assessed
❑Real Property ❑ AnnuafyAssessed
• Mobile Home(IC 61.1-7)
Name of 0\& a
Address of mortgagee or contract seller(number and street dry,state,and ZIP code)
Name of assignee or other owner wt�NC Cµ age � ) S g IS
\ \\ �`CYO C1J!
Address of assignee(number and street dty,state,and ZIP code)
Does applicant awn property in any If yes,what county? requested If yes,state amount of deduction
other county X(��
in Indiana? ❑Yes 0 No 1 (J 0 N
A person is not entitled to this deduction unless the pt 1)1':l\\'C 1" �l indebtedness that is recorded in the county
recorder's office(including any home equity fine of col he basis for the deduction.
Deduc ion approved in the amount of: Card NO. (\
20 20 20 d.. 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
• er/contract h er of the aforementioned property on date application is filed.
\y .+a�,(1st a )'�A A/1,� Date(mwdh,daY.Yeah'fl��/�//l - a.li ant(r mbar state, nil ZIP code,
Person authorized by duly executed Power of Attorney or by IC 5-1.1-12-0.7 1 Date(month,day,year)
Address of authorized person (number and street city,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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