HomeMy WebLinkAboutMortgage_Dillard . ;_ . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
: n;,_ FOR DEDUCTION FROM ASSESSED VALUATION
FILED
''4 State Fort 43709(R13 110-15)
,_„ ' Prescribed by Department of
which the deduction is sought
Must be filed or postmarked with the CounlyAuditor or County Recorder of the county where th property's 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 CounftrAuclit
where the property is located during the twelve(12)months before March 31 of each yiire• u&bi gV'tU DIT9R
See reve de for additional instructions and qualifications.
Applican ownercgfit�ct buyer
res ins on reverse s' } ciy-- 0 .0 , /� e
T ' is ,Key ben legal description Record number Page number
6 - fi-k,7-,50/- 'Ill-026--Ody , ,76,.?o aaa4
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 of application legal or equitable owner?
�� ❑ Yes ❑ 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' = r roperty in question:Annually Assessed
74 Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1 7)
Name of mortgagee or contract seller
OC.2i'( 4
Address of mortgagee or contract seller( b r and street city,sde) j /1 S- ___
Name of assignee or other owner or holder of mortgage l v O a a
Address of assignee(number and street city,state,and ZIP code) Drawer NO
Does applicant own property in any If yes,what county? What Taxing.District? I - :lion
other Indian my Card NO.
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person ! county
recorder's office(including any home equity line of credit that is recorded in the county recorders ounce/urea ra Inc ____-
COUNTY AUDITOR
Deduction approved in the amount of.
20 20 �/ 20 20 - 20 ' 20' 20
Signature o Auditor a//�— County • Date(month,day,year)
/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 application is filed.
Signature(owner's full name) Date(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code) I
`' / e,•-I 5-' ( ler1,4 C.,-re 4., C 1.'C Le p ?'9/'•�.�[..e Te eT-''.. /t,�7 / O
Person authorized by du executed Power of Attorney or by IC 8-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for oeriury can include imprisonment VD to two and a half years and a fine not to exceed S10.000. r T Tr—ti,