HomeMy WebLinkAboutMortgage_Willis (3) 1 _>. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;,% FOR DEDUCTION FROM ASSESSED VALUATION
.,`aI State Form R � ���j q
y/ ( 13/10-15) ()1, yr 1 11"a -.', d Prescribed by De artment of Local Government FinanceA;I.S‘r1
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INSTRUCTIONS: File Mark
To be filed in person or by mail. Fo fil d 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 I 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 contract buyer- restrictions on reverse side)
3crc 'hc Asly\ w Il1►s .
T istnct K numb /lega ption Record nu r P ge rum er
R 1'-� --2o3 -o(1) 3 go--0 Z� t s 3 64
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortg e/Contract indebtedness unpaid as of Is the pp'cant the sole
assessment date,current year assessment date,current year date a�plica(ieit O, O�j legal uitable owner?
1`661�((��[j[ OL Yes ❑ No
If no,what is his/her exact share of interest? If owned with meone WI&than spouse,indicate with whom
if name on record is different than that of applicant;indicate below: I e property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
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Nam o ortgage . con e
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Address of mortg. -�• contract se Ier(num r nd "�et city,state,and ZIP code) if IL. ,
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Name of assignee or other owner or holder of mortgage 2019
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Address of assignee(number and street city,state,and ZIP code) i
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Does applicant own property in any If yes,what county? What Taxing District? Has this deduction it: 't- -, rai• State amount of deduction
other county la 0
in Indiana? ❑Yes ❑No ocur ent ye ti. •No
A person is not entitled to this deduction unless the person has a balance on the persons 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 amoun t:
20 t ' 20 ` 20 20 ' 20' 20
Signature of County Audit. , 1 County Date(mon vgy,�e
1,We certify under the pena ty of perjury that foregoing information is true and correct and that the applicant((is reside t df Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
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�)Ail Da t a i - addr nu a s 4,c'ctri-
Fuft,and Z ode), r► /�
Person authorized by duly executed Power of Atto = or by IC 2-1.1 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.