HomeMy WebLinkAboutMortgage_Marsh ems, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ll FOR DEDUCTION FROM ASSESSED VALUATION fig C�
,'_: State Forth 43709(R13/10.15) �. /^,T 0451
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�- Prescribed by Department of Local Government Finance `"J1111"7(JJJ W( "` 1
INSTRUCTIONS: _ File Mark
lb 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 immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county ❑ County Recorder
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 instructionsi "and qualifications.t( oonaasee rg�y>�hs___,-L-side)
Taxing District 1 al Re n Record ne
-14 -zo1 =000RG -oy7 20 ��ber Page
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortq ge/Contract indebtedness uwpep as of Is the nt the sole
assessment date,current year assessment date,anent year date appl r CY legal a itable owner?
II L`1 Yes ❑ No
If no,what is his!her exact share of interest? If owned withne er thin spouse,indicate with whom
If name on record is different than that of applicant,indicate below: property in question:Annually Assessed
Real Property 0 AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ETP`r- . . -LE t)
Address of mortgagee or contract seller(number and street city state,and LP code
Name of assignee or other owner or holder of image MAX 16 2019
Address of assignee(number and street,city,state,and ZIP code) ha/t�
aum.cilii
Does applicant own property in any If yes,what county? what Taxing Dist*'dN C 011kda d@dJMOr1 a requested If yes,state amount of deduction
other county l't U on property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑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 fine 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 I 20 20 20 ' 20' 20
Signature of Court utor ` \--kte, enmity Date(month.day,year)
I/We ce - er 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.
Siganre(owner's rufiname) Date(r�r�,
rt^�,�y, ,j ►I , h rPl {},rod _ S t11111f C l7g -
Fu0 • r of 3pg- number and eqf,city, cop ,1 C ,n^ 49- C� O
I` NNN M 1✓� Jyl\ IL\` iva\
Per • authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(mddy, g '
Address of authorized person (number and street city,state,and ZIP code) 11`6
•
The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed S10,000.