HomeMy WebLinkAboutMortgage_Mizeur ,�-�--s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Ecoo)`tt ' FOR DEDUCTION FROM ASSESSED VALUATION 1 I �r�
State Form 637o9(R13 f 10.15) �N LC AI :111 . 11- r2✓12
— Prescribed by Department of Local Government Finance "ip 1Jky.l' 1 IC:Dil Ma �/�"1
INSTRUCTIONS: U File Mark
Ni be filed in person or by mail Fo led 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 County Auditor or County Recorder of the county where the property is County 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 sought
See reverse side for additional instructions and quafificatons. �,{� 1% �� - /�
Applicant eror contact buyer-see restrictions on reveemesiee) to `�qY��),
soli T I' i Ze d . . ,.
Taring District ! de-Gumboil— •u 4 ber etPage number
i20o. . .Sago e6 \� /Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mort$'iT
I Contract indebtedn pai4of is the ap
assessment date,anent year _assessment date,current year dat V l O legal err
• rkis ❑ No
If no,what is his/her exact share of interest? If owned withcne otheriman spouse,indicate with ' OJ
� �ssnaG
If name on record is different than that of applicant,indicate below. X
propety/Nfpr'suon:Annually Assessed
PrRy ❑ Mobilee Homme(IC 6-1.1-7)
Name of moee or contract ser 0 ,l
Address of mortgagee or contract seller(numb and street dfy,3fate,and LP ) / U I t� _ /
Name of assignee or other owner or holder of mortgage O'-- d V —
Dra)l:aI- NO.......
Address of assignee(number and street city,state,and ZIP code) .
Card NO.
Doer countypicant oven property in any If yes,what county? What Taxing District? Has this •....................
in Indiana ❑Yes 0 No current
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 line of coedit 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
owner I contract buyer of the aforementioned property on date application is filed.
ture(owners NO name) /}}}/���yn',N�,/� ,{`tp�J1,'��'•�j�^.p1, Data(mot th1',dayyye
'.-maddress (nud>ber and stoat�`'state Pcotlgy pn 1 `��j-� �� '
likt
6 c r0•0r SSS (OCt1L C // ^^^ll !j1 U, 0
Person authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7 v� Date(month,day,year)
Address of authorized person (number and sheet 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 510,000.
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