HomeMy WebLinkAboutMortgage_Goedde (9) �,, . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E'`'__.,,, FOR DEDUCTION FROM ASSESSED VALUATION S fN1 y€^ Fp�,
.�. '-. State Roan 43709(R13/10-15) .- gyp_ ,J
Presrnbed by Department of Local Government Finance 7
File Mark
INSTRUCTIONS: DEC 2 0 /pis
To be filed in person or by mail. orm filed with:
Filing Dater 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 grope is. • ty Auditor
located on or before January 5 of the immediately succeeding calendar year 0,
2) Mobile/Manufactured Homes not assessed as Real Property:Must Me with the County Audbrr hs�yyy�,�t,rV1�j County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deOga(.Y%dnl.S bOlJo TY Al I fIIT(1R
See reverse side for additional instructions and qualifications.
Appligasrivm7 or c nt rd buyer-see restricts an reverse side)
/,c,G�t��C(Z�yvtJ St- l �z tea—'
T g District Key number I legal desaiipton Record number Page number
41 -/ 9-3 a - Jjo0 - oo ,2. 7a S- re) ply aol8 3333
value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
accowarnent date,current year assessment date,anent year date of app&a11n • legal or equitable owner?
50 000 ❑ yes El NO
If no,what is his l her exact share of interest? if owned with someone other ilia spouse,indicate with whom ,
If name on record is ciderent than that of applicant,indicate belovr. Is in question:Annually Assessed
Real Property. 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /�
Address of mortgagee or contract seller(number and eG city,sMte.and ZIP code)
Name of assignee or other owner or holder of mortgage
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 ded • 4 0 / S.
--
other county onpropertyf Drawer NO
in Indiana? ❑Yes ❑No current year
A person is not entitled to this deduction unless the person has a balance on the person's mortgage, a_3 3 3
recorder's office(including any home equity line of credit that is recorded in the county recorder's off Card NO.
-.:J
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 correct and that the applicant is a resident of Indiana and
( owner!contract buyer of the aforementioned property ono date application is filed.
) signature(owners full name) l " "`�"�
/2 -�-F ull resident address of appnt(numbej
heet city,state,and ZIP code)
166 9 E /co /s� ���, nT 7rl �1743� Dale(month,day,year)
Person authorized by drily executed Power of Attorney 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 hat years and a fine not to exceed$10,000. _