HomeMy WebLinkAboutMortgage_Church (4) -� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
� ._.. _ 2. FOR DEDUCTION FROM ASSESSED
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(awner o con bu er-see restrictions on revers sr e)
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Taxing District Key number/legal description Record num er Page number
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Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of 'Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date f app do pJ legal or equitable owner?
II oOO — , t1�ui Yes ❑ No
If no,what is his/her exact share of interest? If owned wi someone aer thrisetat v. i
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
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!� [ Mobile Hame(1C d6-1.1-7)
Name of mortgagee o///rrcontract seller 2,1_16
n,}\ (�/� fieist.ecadt f
gA re of mortga g or contra (number and street.city,state,and ZIP code) v
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Name of assignee or th r owner or holder of mortgage 7
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Address of assignee(number and street,city,state,and ZiP coo
Does applicant own property in an If yes,what county? t-0 / .-• S Q(� v e If yes,state amount of deduction
other county ( UU
in Indiana? ❑Yes ffNo - No
A person is not entitled to this deduction unless the persc edness that is recorded in the county
recorder's office(including any home equity line of credit Drawer NO sis for the deduction.
Deduction approved in the amount of: Card NO.
20 20 20 20 20
Signature of County A to c County \ Date(month,day,year)
,o,„ so, 12 26_,q .
I certify under the enalty of p rju th above and foregoing information i e and correct and that the applicant is a resident of Indiana and
owner/contract buye f the re entioned ope on date application is filed.
ignatur (owner's full na ) Date(month,day,year)
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ull reside �d f a pli (nu et,ci ,state,aid ZIP code I -1-9-6
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Person authorized by duly executed Power of Attorney or by IC - .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.