HomeMy WebLinkAboutMortgage_Armstrong STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Forth 43709(R13/10.1� boon �,u,,,r,f{.(fi{r�PrescribedPresed by Department of Local Government Finance �J r"r
INSTRUCTIONS: File Mark
Tb be filed in person or by mail. Farm fi with:
Filing Dates 1) Real Properly: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 is County Auditor
located on or before January 5 of We 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 March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Apnit a caer&-5 5► co reverse side)
✓ District number I Record te 1. 2Zo1- uo1_ 6 (Z-o� lo Page number.
• value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtednessunpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date application legal or it bte owner?
• RnI J 00° • Yes ❑ No
t no,w Ws is his/her exact share of interest? If owned with ne r man spouse,indicate with wham
t name on record is Efferent than that of augment,indicate below. m. :_:. :�. � Assessed
,g�- = 3 Assessed
/ • Mobile Home(IC 6-1.1-7)
a Name of mortgagee or aonaa seller ( d0 n ,1I 1 — NOV 16 2018
1.
Address of mortgagee or contract w an v seller(number and street,city,state,�alnd ZIP code) ,r�
224 6 (1 / ?\/1 `ke - f V 41 T-1-i 1 `
9A 41
Name of assignee or other owner aMlderofmortgage GIBS OUNT}�AUDTO' R ,
Address of assignee(number and street city, --- (� (/W,<'/1_'I�.f- `_''A'r`�.,JI`.,•
Does applicant own property in any If yes,• county ///� / (`_ Suction been requested If If yes,state amount adedur�on
in Indiana? . Oyes ❑No Drawer NO V f/ (J,t" i for ❑Yes ❑No
A person is not entitled to this deductior •or contract indebtedness that is recorded in the county
recorder's office(including any home or /,,,,�f� Tice)that is We basis for the deduction.
Card NO. .... .(g
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
owner I contract buyer of the aforementioned property on date application is filed. .
XSigners/Funame) �'' Date(month,day,year)
Fulladdress of applicant(number an.I. Il- I �' �U
illy,state and ZIP code)
06 Rah s+ 1 ' ` *ov) � TN t&
Person authorized by duly executed Rowena or by IC 6-1.1-12 Date(month,day,year)
Address of authorized person (number and street city,slate,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.