HomeMy WebLinkAboutMortgage_Fischer (2) ,„... STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
� a� ;' FOR DEDUCTION
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.
piicant tn.., ------ "5uyer-see restrictions on reverse side)
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TaxingDistrict K number/legal description Record number Page number
Co�kt��� 0.-‘.. Q °1. - I .- Do - o Do -S (a-no (Q20I 2 14 V
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
i C OO ❑ es ❑ 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 different than that of applicant,indicate below: Is the-.-,erty in question:Annually Assessed
i - n ' 11 • nuallyAssessed
4 bile Home(IC 6-1.1-7)
Name of mortgagee or contract seller V . 1
Address of mortgagee or contract seller(number and street city,state,and ZIP code) A 2019
DEC Name of assignee or other owner or hob • n Pt SCl/lt-r-
pineti-OR
Address of assignee(number and street _ % i%k Y
1Or r 1� --it er G,Bs°N CO
Does applicant own property in any If :deduction been requested If yes,state amount of deduction
other county (((/// erty for
in Indiana? Yes 0 No year? ❑El Yes 0 No
A person is not entitled to this deduction unless me person nas a valance on are person a uru,ryage 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 amount of.
•
20 20 20 20 _ 20 ' 20' 20
Sig re of County Auditor s County Date(month,day,yea
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date appli 'on is filed.
Sig tare ow s full name) �-�p ^ ))..f2A Date(month,day,year)
A�21`� /C41.J 4e V
wc+ la- 1 —( '1.
Full resider ad less of app ica t(number and street,city, te,and ZIP code
Person authorized by duly ex uted Power of Attomey 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 forneriury can include imprisonment uP to two and a half vears and a fine not to exceed S10.000_