HomeMy WebLinkAboutMortgage_Seib t , STATEMENT OF MORTGAGE OR.CONTRACT INDEBTEDNESS yyy111 Con Township Year /
1;1-= --, ;% FOR DEDUCTION FROM ASSESSED VALUATION
:aft= State Forth 43709(R13/10-15) s'iwN
Y It.`c 9 ��
`. '8' Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly.;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 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.
Applica nelQr contract bv e"1 errestrictionsonreverseside)
Taxing ,,,
Di •ct j /legal n Key b r g cnptio Record number Pa a number
- 1&-0.3 _�00� � -o - . 20« L)$6�
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortga Contract ind tednessipaid as of Is the plicant the sole
assessment date,current year assessment date,current year date o li ti b" legato wtable owner?
®� Yes ❑ No
If no,what is his/her exact share of interest? If owned with so e0 a othe/ pouse,indicate with whom
if name on record is different than that of applicant,indicate below: s th •roperty in question:Annually Assessed
;r Real Property 0 Annually Assessed
������ Mobile Home(IC 6-1.1-7)
Name of mortis r co tract sell. 1 c
' ■ • '"Address of mortgage nfract sellfir
and street,city,slate,and Z/ code) "
Name of assignee or other owner or holder of mortgage a7 EP 2 3 2019
Address of assignee(number and street,city,state,and ZiP code)
• GlasoN n
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been re fi A ��(ateR amount of deduction
other county11 O
in Indiana? ❑Yes 0 No currrent properly
❑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 amo t of:
20 2 20 20 20'
itt „.......*\„...
Signature of County Auditor County Date(m, y,
i q
I/We certify under the penalty of perjury hatabove foregoing information is true and correct and that the applicant is a esident Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
( lure rowner'•j/n. e) bi- Date(month,d y„Kea to
-VmeYr
i ;,: ss o i' t v er rid t c' state far code
4
Person authorized by duly execute Power of Attorney or WIC 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 periury can include imprisonment up to two and a half years and a fine not to exceed S10.000.