HomeMy WebLinkAboutMortgage_Meyer (9) �. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ?
�' State Forth 437g9(R13l 10.15) ( QV\ 1�� a01�
Prescribed
by Department of Local Government Finance J
•
INSTRUCTIONS: • File Mark
lb be filed in person or by mail. Fo 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. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly is located daring the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Appinnt Omer or condact seeKKaa�. -A reverse
�side) --� �'1 t�( 1!_ ''"�� t� lurtp+6le�
Taxing District �\1 legal V `{\J U _O 01 .90 67 " a • 2 in•Hnn RecordAU t Page numb3r .
Assessed value of real property as of �b �Mo tgage/Contract Indebtedness unpaid as of Mortgage/Contract indebted ess unpaid as of Is the solee
assessment daa,anent year assessment date,current year date of legal o table owner?��0(T) Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone Other than spouse,intcate with whom
If name on record is different than that of applmnt,indicate belvx: 1s property in question:Annually Ac ascwt
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of m o �or tract seler
rct IL F !)
Address of mortgagee or contract seller(number and sheet,city,state,and LP code) I I
Name of assignee or other owner or holder ofux,.tyage JUL 16 2019
Address of assignee(number and street city,state,and LP code)
Does applicant own property in any If yes,what county? What Taxing DBnstNN C O' n requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 0 No current year? ❑Yes 0 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 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'*.tint of
20 201 AAA 20 20 ' 20 ' 20' 20
Signature of County Aud - A r1) County4/1..)p J,\� Dare( g
( v �/ VI/We certify under the penalty of perjury that the above and foregoing information isnil correct and that the applicant is res' nt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
S' re(ownueYs ame) Date( lal
t
Full I 1 of V` (p1 t v\Pi S' 1 ' '1 b .
Person authorized by duty exeared Power of Alto ey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street 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 S10,000.