HomeMy WebLinkAboutMortgage_Taylor (2) �.;,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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,� �: FOR DEDUCTION FROM ASSESSED VALUATION
�`'Z State Form4by (p13/1 -15)
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Prescribed by Department of Local Government FinanceILE
INSTRUCTIONS:
Td be filed in person or by mail. ' filedavan
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought SE F L U I C
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on orbefore January 5 of the immediately succeeding calendar year. ❑ rder
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 March 31 of each year the deduction is so
See reverse side for additional instructions and qualfrcations. G I BSO N COUNTY AUDITOR
App&ant(owner or contract buyer-see resbicdons on reverse side)
Iraranderl ci- 'S0.f-,e. 1 Qu ‘Qc
Taxing District Key number I legal description Record number Page number
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0 -‘ 3-D10-U‘00- nap. R-co 2 3-o i 8 8 0 8
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,current year date of application ,, legal or equitatte owner?
S `W
5rO(,i: D Eries ❑ 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 different than that of applicant,indicate below Is the property in question:Annually Assessed
0 Real Property 0 AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller - ___________
Address of mortgagee or contract seller(number and streec.diy,state,and ZIP aide)
Drawer NO..,..2AIl .
Name of assignee or other owner or holder of mortgage
Address of assignee(number and about city,state,and LP code) Card 1NO, a J813.
Does applicant own property in any It yes,what county? .What Taxing District? Has.,...,.-..__ __ lJ..•.
other county on Property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction 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 the 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 coned and that the applicant is a resident of Indiana and
er I contract buyer of the aforementioned property on date application is filed.
S. -e(owrrer3 Date monde,day,year)
0 ' I ( I� t d -ate-� -
F dress of...•.- '(number city,state,and ZIP code)
34g l S . .S1 • ) COLA_ VtnCk C„ k . . Ni\—\LQ\sC` - -
Person authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penaltiesfor perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.