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HomeMy WebLinkAboutMortgage_Lienemann (4) 0,_,,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year Iii ' re ie- �. FOR DEDUCTION � , AV FROM ASSESSED VALUATION , Prescribed by Department of Local Government Finance INSTRUCTIONS: • File Mark To be filed in person or by mail. Form 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/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 sid r additional instructions and qualifications. Applicant contract buyer-see restrictions on e side) N O 6e44,/171 Cr axj Record nnumber Page number Ass of't property- Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole assessment date, :Irerrtyear assessment date,current year date ofapplimil'•n legal or equitable owner? 4 iVG0,5 21 0 Yes ❑ No If no,what is his I her exact share of interest? If owned with someo -other than spouse,indicate with whom If name on record is differentthan that of applicant,indicate below: Is the operty in question:Annually Assessed eel Property 0 AnnuallyAssessed ' Mobile Home(IC 6-1.1-7) Name of mortgagee or contract setter aj - FILED Address of mortgagee or contract seller(number d street city,state,and ZIP code) Name of assignee or other owner or holder of mortgage J,q N 0 9 2020 Address of assignee(number and street city,state,and ZIP code) GInpoi lttz Does countyicant own property in any If yes,what county? What Taxing District? Has this deductionbeen reques'tb f -eta Amount of deduction otin Indiana ❑Yes ❑No current year?for ❑Yes 0 No 'ILJU1 rO R 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 amount of. 20 20 20 20 20 ' 20' 20 Signature of Auditor , s ::a..e..„ County Date(month,day,year) /ft,J 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 afore tipped property on date application is filed. 1 Signature(own lam ) Date(month,day,year) ell_____-- Full resident address of applicant(number and stet,city,state,and ZIP code)—7/ 0-7 i,J L/O0 0,,,_)-(o a)/ l_ Co 617AJ5- 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 oeriury can include imprisonment LID to two and a half years and a fine not to exceed S10.000.