HomeMy WebLinkAboutMortgage_Lofton s� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
"'` :; FOR DEDUCTION FROM ASSESSED VALUATION
_ =' '�'• State Forth 43709(R73/10-15) (-A t/)J�
v Prescribed by Department of Local Government Finance v.Jn,1/
INSTRUCTIONS: File Mark
To be filed in person or by mail. F 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 CountyAudiitor 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 I Manufactured Homes not assessed as Real Pmpert ust file with the CountyAuditor of the county
where the properly is located during the twelve(12)months before March 31 of each yeeartie deduction is sought
See reverse side for additional instructions and qualifications.
Applicant( or ct buyer- son reverse side)
(owlet
t 1 ( a ct)
Key' / desai Record num r Page number
T' � " 1L 1 —koU-CO . 61� org 211. 8 5218 •
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
assessment date,current year assessment date,current year dateg application legal or equitable owner?
( j 1-10.000 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with/orneone othdr than spouse,indicate with whom
II name on record is different than that of applicant,indicate below. Va property in question:Annually Assessed
r `F --An Real Rope- Home QC 1.1-7)
Name of mortgageear contract seller � \i� ^� I .
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
DEC 31 2018
Name of assignee or other owner or holder of mortgage
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Address of assignee(number and street,city,state,and ZIP code) f(f:GT-S1."
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GIBS^P-t COUNTY Pte..t DITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested -If yes,sla amount of deduction
n Indiana?other n ❑Yes 0 No currentpr year?oPertY for ❑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 recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
20 20 20 20 20 ' 20' 20
Signature of County Auditor County Date(month,day,year)
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I/Y✓e 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
ct buyer of the afore .-ntioned prop rty on date application is filed.
ignatu nets fui�n'a,m�J Date(month,day,year)
'1 Q. ` /�i ; ,- - iv or( ) I13) - k7 .
F 1) rtlress otapphrant u r S turd ZIP ::Z ,
Person authorized by duly executed•• - .,.rney or:. IC 84A-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.