HomeMy WebLinkAboutMortgage_Fleming (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
Goci' FOR DEDUCTION FROM ASSESSED VALUATION __-
State Form 4by Department ento
P by Departmerd of Local Government France
INSTRUCTIONS: _ ! I le M
lb be filed in person or by mail.
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 isa ii G arty Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is s
See reverse side for additional instructions and quafffications. 41
AppEcant(owneror connedbuyer-seerestrictionsonreverseside) GIBSON COUNTY AUDITOR
m& r --� 4 Carr le_ff: tr\ -
V� -a� a- Key�, y 0_ \O1 -OCC .-\93-Oa-1 Record p as
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sale
assessment date,current year assessment date,anent year date of application L_ legal or equitable owner?
It I — ❑ Yes 0 N
lino.what is his/her exact share of brie st? If owned with someone the.spiv me,indicate with whom
If name on record is different than that of applicant,indicate below-. is the in question:Annually Assessed
Property ❑ AnnuallyAssessed
• Mobile Home(tCs-t1-T)
Name of mortgagee or contract seller
- `IRO t ens (i? da,rN1L
Address of mortgagee or seller(number and street city,state,and ZIP code)
Name of assignee or other owner or folder of mortgage
VT w C \01 11 o Q . 3taLiP Pr r'_ C -a-
Address of assignee(number and 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
other county on property for
in Indiana? D Yes ❑No anent year? ❑Yes ❑No
A person i s not e n t i t l e d t o t h i s d e d u c t i o n u n l e s s the person has a balance on the person's m o r t g a g e r• - '- ' ,--"Th 7. Hier N' '" "1'tha' "^"-
recorder's office(including any home equity line of credit that is recorded in the county recorder's ofh 0 / p — O
COUNTY AUDITOR o�2{- O d 5 6 d •
Deduction approved in the amount of:
Drawer NO - ,
20 20 20 20 20_ i. . . -
Card NO.
Signature of County Auditor County •
1
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.
Si (owner's St) Dare(month,day,yeah
)(Full address of applicant(number and ZIP code)
84/ Al 17.5E k4 I 7-, AI 5e -
\Person authorized by dory executed Power ofAttomey or by IC 6-1.1-12-0.7 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.