HomeMy WebLinkAboutMortgage_Hames STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� County Township Year
Ai ;. FOR DEDUCTION FROM ASSESSED VALUATION 151494
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�'` State Fono 43709(R13/10-15) F1•• `49 p•1 /r 1`I
Presabed by Department of Local Government Finance r , �R�V,1 G/�+
INSTRUCTIONS: File Mark
To be filed in person or by mait nn filed with:
Filing Oates 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)mur,ths before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Appi ner or contact bttyer-see restrictions on reverse side)
MO
Taxing ¢�s J 401 despppq R �
+ of'allp& . r\ Jt-10 I �0o qGs �2 - �\CI 2 2b �.-...
Assessed value of real property
as of Mortgage/Contact indebtedness unpaid as of Mongag /Contra[lct,indebtedness unpaid as of Is the applicant the sole
aeex.ment date,cuneni year assessment date,current year date 2 I `149
_ 9 legal or a oaneN
JC '/"\lM1 or
❑ No
If no,what is his I her exact share of interest? If owned with ne other fhanlpouse,indicate with whom
If natter on record is different than that of applicant,indicate below I property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(1C 6-1.1-7)
Name of mortgagee or contract sell
Address of mortgagee or miib t seller(number and she,-'-Ct.rrh Ibleigi
/L _ �ILE
Name of assignee or other owner or holder of mortgage may`�(9/ '-
Address 1 ��
of assignee(number and street dry,state,and: ��J 14C AUG 2 3 2019
Drawer NO
• Does applicant own property in any If yes,what counq :this deduc• If yes,state amount of deduction
perty for
in�Indiaanna?nty ❑Yes ❑No ent A.JDITOR
A person is not entitled to this deduction unless The Card NO. in gage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recoroeo in me canny rm,r,ders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 / 2^0_ \ 20 20 20' 20
Signature of County ' ]ll_ /�a./7 \ Coun /1 Dal, �t ye ri
I/We certify under the penalty of perjury that the above and foregoing inform' 'is and rconed and that the appli resid3 n of Indiana and
yowner/contract buyer of the aforementioned property on date application is filed.
Sig (owners rue me) vinT1 •FAresIdent adders of►epicdnt(nu and street city,state,and VP e)
Person authorized by duly executed Power of Attorney or by IC 1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,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.