HomeMy WebLinkAboutMortgage_DeHaven P, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.'s_, -' FOR DEDUCTION FROM ASSESSED VALUATION � , D
'- State Forth 43709(R73!10.15) C�19-��'n \ 1�S� 2O .
Prescrbed by Department of Local Govemment Rnance J
INSTRUCTIONS: File Mark
lb be filed in person or by mail. F 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 during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
nt(owner or blxye - reverse side)
_ Districto� Key d �7 Yn/yli gd�^u�np7Lpnt) s cAvc ) .f�� � _e
TQ gTOS -G � —f J I00 —OO 9c � c t._4 . Record number Page"SZ
Assessed value of properly as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtednestppaid as of fIs the applicant the sole
assessment date,amend year assessment date,current year date of ap�3 O^� legal o noble owner?
UYes ❑ No
If no,what is his/her exact sham of interest? If owned with someo fir ttlin spouse,indicate with whom
If name on record is different than that of applicant,indicate below. property in queslion:Annually Assessed
Real Property 0 Annually Assessed
• /�l Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r, 1-S V"`6' O ''''����ttrr ,
Address of mortgagee or contract seller(number and street city, re,and ZIP code) F,I I j
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
JUL 2 3 2319
Does
applicantn own property in any If yes,what county? What Taxing District? Hasr thi • ested If yes,state amount of deduction
otin Indiana? ❑Yes ❑No Epp WeAZIOI
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 amount of.
20 i Lit 20 20 • 20 - 20' 20
Signature of County Auditor Crnmty Date(m ay,
� 7� -9 .
I/We certify under the)h:n- ty of perjury that the above and foregoing information and correct and that the applicant is resid nt of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
XSig re(owners MU me) q/ Dale(math day,ilean� '
F esidegtad I tru rind t atafa antl )� J1111
Person authorized by duty exeal ed Power If Attorney 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$10,000.