HomeMy WebLinkAboutMortgage_Brakebill STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,e?, FOR DEDUCTION FROM ASSESSED VALUATION G •�[I/� 11, r1
State Font 43709(R13/10.75) e9Sv VJ hAALC1 &_ol� .
�-- Prescribed by Department of Local Government Finance
INSTRUCTIONS: • File Mark
lb 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/Mane fay-lured 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 instructions and qualifications.
Applicant(owner or contract see restrictions on nave )
teAt
isthei
Reco
Page number
zDWh��� _ 26 — de n 00—o0oIb3 —OOC . aoiq _ i- S-Z
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole'
ncmccTent date,current year assessment date,current year date of r..P legal or us owner?
4L �� • ❑ ❑ No
If no,what is his I her exact share of interest? It owned w h e other man spouse,indicate vNh whom
If name on record is different than that of applicant,indicate below. property in question:Annually Assessed
Real Property 0 AnnuallyAssessed
Moble Horne(IC s-1.1-7)
Name of mortgagee or contract seller G �{�'�'/�V-V A-��� 7yf E
Address of mortgagee or contract serer(number and street d state.a9 LP code p � ilk .
Name of assignee or other �R �f n �1 M
G �+ ,..,� ( MAY 13 2019
Address of assignee(numbs M or t , f'Q ILut✓v J/y/
Does applicant own property 1 1 ,.—r`.^� t"1�`' � Has this tleduction t es,state amount d deduction
other county , ' �' J onl�perif�m6�yqr�NN COy��Y AUDITOR
in Indiana? ❑Yes [ anent year? LJ Tes LINO
A person is not entitled to L I _ I ferson's mortgage or contract indebtedness that is recorded in the county
recorder's office(indudutg wnty(soordet's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount at
20 20 206C3)±)
20 20 20• 20
Signature Aud ` YY\1 _ County • Date(mday�al � `
I I We certify under the pens 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.
S' a�re�wn turn Date(r. ay, ar)'
F �O address ' app' t(numb--arrQ sheet,pty tie.and ZIP code) ‘AM r-'r;
Person authorized by duly executed Power of Attorney or by IC e-1.1-12-0.7 1 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 two and a half years and a fine not to exceed S 10,000.