HomeMy WebLinkAboutMortgage_Butts STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
aeltilt. FOR DEDUCTION FROM ASSESSED VALUATION �� ��
State
res ibeorm 4by 9 Department
nto
Prescribed by DepaMlerd of Loral Government France
ILE
INSTRUCTIONS: . . File Mark
To be filed in person or by mail. OCT .nn a!"'•c :
Filing Dater 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 is ❑a County Auditor
located on or before January 5 of the immediately succeeding calendar year. ,' •
!' - my Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coun �`•'N'+"
whem the properly is located during the twelve(12)months before March 31 of each year the deductigt RI SWIM O. ,- - . :
See reverse side for additional instructions and qualificatioolnns.
Applicant( - contract•' ,- , (` r k V ` - ^
Taxing District Key number I legal description Record number Page number
e � era- a -L -ebb- nol .ck &- ODD 10t � 3aI
Assessed vane of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage 1 Contract indebtedness unpaid as of Is the applicant the sole
assessment date,amend year assessment date,current year date of application legal or itable amen
y b�ODa l Yes ❑ No
If no,what is his I her exact share of interest? If armed with someone otter than spouse,indicate with whom
t name on record is different than that of applicant indicate below. Is the property in question:Annually Assessed
Real P uva ly 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or coqtract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code) Y ( `,(t-a_ Q _ _�
.j
Name of assignee or other owner or holder of mortgage Dra 15'CI• INT
Un O.
Address of assignee(number and street dty,state,and ZIP code) Ca r(l 1\i
ODoes mer applicant own property in any If yes,what county? What Taxing District? 'T 7Cr Tot& ••'.'.••.. iucfion
—
in Indiana?ty ❑yes ❑No 1arrent year? ,_. .--
A `-�V
parson is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness Char lb 1P .._ he county
recorder's office(including any home equity fine 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 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 bred.
Signature(ow fun ) _. r < Date(month,day,yeah
or
f-/ 5
kFer address of applicant(number and street,city,state,and ZIP code) .
1 /ai A) SSo E Frnt ,d Scud -tn. J/761-19
authorized by duly executed Power of Attorney or by IC a-1.1-12-0.7 Date(nrwrtr,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.