HomeMy WebLinkAboutMortgage_Sollman (16) aSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Slats Forth 43769(p 1
TT P
Prescribed by Department
of
of Local Government Finance �L J
INSTRUCTIONS: Mad
Bark
To be filed in person or by mail o co :
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought DEC 2 g. � ati
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. /1 �Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the p u
where the properly is located during the twelve(12)months before March 31 of each year the ded
See reverse side for additional instructions and qualifications. IV ..i.JU idTY AUDITOR
Applicant or contact buyer-see restrictions on reverse side)
Twin% Key number/�/;l� Record number Page number
l . .2 3 - 0 9 moo _ col. yoq_o.tY //anent a- 6111- .
ed value of real property as of 1 Mortgage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the apt& nt the sole
assessment date, rtest year assessment date,current year date of application legal or equitable owner?
-5 Oo0 0 Yes 0 No
If no,what is his!her exact share of interest? If owned with someone other than spouse,indicate withir whom/1' rM
If name on record is different than that of appricant,indicate belay. ,b L e rn4A./ /DA.1 ) _ —
Name of mortgagee or contract seller ` --� ,, ,�-�J / / �r�' e/aZ
Address of mortgagee or contract seller(number and sbuet thy,state,and ZIP code)
Name of assi9 or other owner or holder of mortgage r -
�/�/J/,/{� O Z 4-1.-i air✓ `o?-o'9 - 2J .lam'-//f pyb.`C.
Address of assign (num ands6Eelcify,stata,FFd LP code) tent--)..)
/
Does applicant own property in any If yes,what county? What Taring District? Has thence on prlyfor been requestedr If yes,state amount of deduction
other county in Indiana? ❑Yes 0 No current year? ❑Yes 0 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 line of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ob
•
20 20 20 20 20 ' 20' 20
Signature of County Auditor County - Data(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 on date application is filed.
Si re(ow fulrname Date(month,day,year)
. • e. .X� �/
Full resident address of applicant(number and sheet,city,slate,and ZIP code)
JM -37 S eQSO F it„„bstwclt irJ. `J7G39
Person authorized by duly executed Power of Attorney of by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street say,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.