HomeMy WebLinkAboutMortgage_Martin (11) FOR STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
GIit-6 -� DEDUCTION FROM ASSESSED VALUATION
State Forth a3709 par f ent or'7V `aV\ mom„n(O 201 q Prescribed by Department of Local Government Finance JJ •
INSTRUCTIONS: File Mark
b be filed in person or by mail. Form filed with:
Filing Dates: 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 property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instnrctions and qua!ificafions.
t w buyers see o creme side)
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Taring Key number/legal descdption Record number Page number
(ill0 26-kl- a-100- aD1 . k0Q-O21 . "-IC) la OS'IQ
Assessed f real as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cumnt assessment date,anent year date of appr 40 legal°o gable owner?
s<m h th 000 Yes ❑ No
r J, \�
If no,what is his/her exact share of interest? If owned with er thafr spouse,indicate with whom
If name on record is different than that of applicant,indicate below pre property in question:Annually Assessed
'Real Property ❑ Annually Assessed
\ Mobile Home(IC 61.1-7)
Nacre of mortgagee or contract /••Ue,`, �f+� IIP ♦ FILED
Address of mortgagee or coact seller(number and A sir*ccity`state,,and ZIP cold-e)r �
contract i,r/1r
Name of assignee or other owner or holder of mortgage FEB 2 2 2019
Address of assignee(number and street,city,state,and ZIP code)
oDoes f applicant own properly in ar, this�u O A Its ,state amount of deduction
in lndianai ❑Yes ON 4o/ 9 - 05 94 current yeah Yes No JUIIUfZ
A person is not entitled to this 1 ;mortgage or contract indebtedness that is recorded in the county
recorder's office(including an; Drawer NO corder's office)that is the basis for the deduction.
z
Deduction approved in the amour .
Card NO.
20 20 20 ' 20' 20
I I i
Signature of County Auditor County Date(month,day,year)
I1 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owners fig Date(month,day,year)
�( 2-22_-kC\
Full resident address w a p" t(number and street,city,state,and ZIP code)
- -3sc i S .k .cL& \bc 0 \•4k s>1 •
Person authorized by sty executed Power of Attorney or by IC 6-1V1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city state,and ZIP code)
The penalties for per)ury can include imprisonment up to two and a half years and a fine not to exceed$10,000.