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HomeMy WebLinkAboutMortgage_Gallegos . ., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year �: FOR DEDUCTION FROM ASSESSED VALUATION State Form 4by Department � Presatbed by Departmen of Local Government Finance INSTRUCTIONS: File Mark To be filed in person or by mail. Form filed with: Filing Date& 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 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 contact buyer-see restrictions on reverse side) Taxing District C. Na tit • P;� TPrtnce.-��- Key lo Imber faai-d'�3nu - bp3 •-eS-® . Record ZO1(\ Se number 5113 Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment data,current year assessment date,current year da_ylof application • legal or equitable owner? W Li (CI , QO, [ is ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom If name on record is deferent than that of applicant,indicate below: is in question:Annually Assessed IBTReal Property ❑ Annually Assessed He Home(IC 6-1.1-7) Name of mortgagee w contract seller �� � � /� av OLrLS ub is e \v�J�J ��Yrl J, Address of mortgagee or control seller(number and street city state,and ZIP code) A Name of assignee or other owner or holder of mortgage ``��OO : vf:�0\9 Address of assignee(number and street city,state,and ZIP code) S`` _`,�t�;pv0\(CR Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested t��za amount of deduction other county ❑Yes ❑No On ttyyeeaar?for ❑Yes ❑r'Nar_.o000��� A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indc edness 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 20 20 20 - 20 ' 20' 20 Sig re of County Audtor C CoL CO Starr DCA ' , Itl-i gad I/We certify under the penalty of perjury that e a e nd foregoing information is true and correct and that the applicant is a resident of Indiana and own /contract b the aforementioned property on date application is filed. are I _ Da month,day,yea 9 ofa num. ,and LP code) 1‘ -% \ 1 rvcc .4-arN_ Person authorized by duty executed Power of!homey or by IC 6-1.1-12-0.7 Date(month,day,yeas) Address of authorized person (number and street city,state,and ZIP code) . The penalties for perjury can include imprisonment up to Iwo and a haff years and a fine not to exceed$10,000.