HomeMy WebLinkAboutMortgage_Ross (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
*r; FOR DEDUCTION FROM ASSESSED VALUATION IB1,..
❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 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 rorcophactbuyer- restco sonreverseside)
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Taxin District Key n ber/legal description Record number Pars!
2 n --� =«- --0 CO _g7 q -oc��`_ SIC 31�-r}Jl L .
Assessed value of real property as of 1[ jM•(gage 1 • •t in.,;btedness unpaid as of Mortgage/Contract indebtedness unpaid es off Is the applicant the sole
assessment date,current year la, me$ •.te,«rre year date of ' tio�3� O O legal uitable owner?
Yes ❑ No
If no,what is his/her exact share of interest? If owned with som ne other than opouse,indicate with whom
DEC 302019
If name on record is differentthan that of applicant,indicate below: e property in question:Annually Assessed
eat Property ❑ AnnuallyAssessed
S_ Y{ Mobile Home(IC 6-1.1-7)
Name of mortgage�-,pr t rq`elletrG I UN Y ITO () )v+
Address of mortgagee oar contract seller number and street city,state,and ZIP code) 'W 5.....
Name of assignee or other owner or holder of mortgage /,
Address of assignee(number and street,city,state,and ZiP code) Drawer NO
Does applicant own property in any If yes,.what county? Wh; s,state amount of deduction
other county
in Indiana? ❑Yes 0 No Card NO.
A person is not entitled to this deduction unless the person has a rat is recorded in the county
recorder's office(including any home equity line of credit that is rE !deduction.
Deduction approved in the am.. of:
20 0 20 20. • 20 20• 20
Signature of County Au.'% ; County ) '0Date`nnt tay,ye r�ol
• '�S iV '`
I/We certify under the penalty of perjury tha ove and foregoing information is nd correct and that the applicant is ii resident of Indiana and
er/contract buyer of the aforementioned property on date application is filed.
S' n tore(owner'stulipame) Date`(mon aye r�
�(j�'� .t / \1Z r�.Jl ll
ci
Full resident address of a i nt(numb rand street city,state,and ZIP code)
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Person authorized by duly executed Power of Attorney or by IC 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 un to two and a half vears and a fine not to exceed$10.000.