HomeMy WebLinkAboutMortgage_Dike (2) E . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
_� County , Township Year
4:;: FOR DEDUCTION FROM ASSESSED VALUATION �I � n ���
=; :- State Forth 43709(R13/10-15) qi Yl S°4 `�(J
- Prescribed by Deparbrtent of Local Government Finance J����,JJJJ���'""``����
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed 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 immediatty succeeding calendar year. unty Recorder
2) Mobile I Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
where the properly is located during the twehe(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and guaal ficabons.
Applicant( or cont_uyer-srrrese Stop reverse side)
Young D 3 . ' l�o1 -opt - lck+ -026 Record
number it_{number s
Assessed real real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness tin as of Is the applicant the sole
assessment date,arrant year assessment date,current year date 0 000— legal o,eg6dWe avne .
\ Yes 0 No
If rn,what is his/her exact share of interest? If owned with oth than spouse,indicate wiliwham /
If name on record is different than that of applicant indicate below piuperty in question:Annually Assessed
Real Property ❑ Annually Assessed
• n 1 r� ^ Nbbfie Hones(IC 6-1.1-7)
Name ofmortgageeorconha3seller 0
11 11�-1�,^,/�^ I1 ,1t ce, ^I
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Yl,'1"\7` •
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,city.stab _ 0 REL)D A- GA.l L JAN 1 2019
b_L
Does applicant own property in any If ye what 1« y s, en to amount of deduction
other county in Indiana? ❑yes ❑No /8— yr 95 ao/a9? $SOWINOUNTY AUDITOR _
A person is not entitled to this deduction unto: tot indebtedness that is recorded in the county
recorder's office(including any home equity lir is the basis for the deduction.
----"Deduction approved inthe am of.
o -
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 on date application is filed. --kin Signature Ws rub n�amJ_Le) /��/(f Date(uamith,Iday,year) Q
�:me). ct hue and. 227.fie LP e) 1 low 1 \ .
-7G%S - S 'fr'c1ee, ct- ()'\ )3() . .
Person authorized by duly executed Power of Attorney or lot IC 6-1.142-0.7 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 Iwo and a half years and a fine not to exceed$10,000.