HomeMy WebLinkAboutMortgage_Pharris STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
6' 1.6
s. FOR DEDUCTION FROM ASSESSED VALUATION n �0��
'- - State Forth 43709(Ms/10-15) ,D60
S,u% Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. 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 properly 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 Properly Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or coltruyer Lyre resArreionts orkreverse siden\r\ot 0
Abk
aT3xN Kgy pi n 3 O�o SRN /O 0 Recgrd Ober As Page number
slue of property as of Mortgage/Contract indebtedness unpaid as of Mortgage I indebtedness unpaid of Ls the ap • the sole
assessment date,current year assessment date,current year date�xna�rnC�^ legal e owner?
Yes ❑ No
If n,what is his/her exact share of interest? If owned with er skouse,n with whom
If name on record is afferent than that of applicant,indicate below: property in question:Annually Assessed
Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee a contract seller /C�'-,-t�•�� cu—
Address of mortgagee or contract ler4 and street city,se c��l.l ..
Drawer NO r
Name of assign Fo0jr age q
�,�yr1� Card NO. g I
Address of assignee(nuatb�al�f J-L��stare,and LP code) I/�' `� �,Y
Does applicant own p, J1M� in any If y 9 a129unty? I �-/ ..! 1 - //5 If yes,state amount or deduction
other county 1 lR� 0.J
in Indiana? ❑Y l 1 uu,euw yew I L.J ,ea uno I
A person is ng,4yearioneCtliattati6t6PAIds9Me person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorders office(mcuding 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 of
20 20 20 20 20 ' 20' 20
Signature of County Auditor County Date(month,day,year)
I 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.
SignaW ( fuffname) aZezisaLtDate(month,�,ye
Full resident address of applicant(number and sheet. attire,and ZIP code)
2@q0►J 50 L \ n 3w `S14).
Person authorized by executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yew)
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$10,000.