HomeMy WebLinkAboutMortgage_Beal ., .-r6�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County TownshipYear
R , FOR DEDUCTION FROM ASSESSED VALUATION
ti oZ� , '
^ fp -`tl� State Form R14/1-20
so's Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. • Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. LI County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the p rt s Et _
located on or before January 5 of the calendar year in which the property taxes are first due and•. able ' -4 II ,of sty Recorder
See reverse side for additional instructions and qualifications.
Applican, ror cont
ractbuyer- ee frictions reverse side) SEp 2.will
2020
,.. a/if&
T- in. tnct Key nu ber/legal description ecord nu ber Page number
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract'ndebtedness utfp �tiWpf J the applicant the sole
assessment date,current year assessment date,current year date.of application op 466t.�t` (table owner?
� ivi 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 e property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller `
i i1 /EL AA.LTO/J
Address of mortgagee or contrac seller( mber and r et,ci , ate,and ZIP col"
Name of assignee or other owner°A lder of m J gage O _7 gia,76 /yam d
r'�—(/)5/
/ 9 /(�rt�j . v
,000
Address of assignee(num.- -n:str/city,state,and ZIP c de)
Does applicant own property in any If yes,what county? What Taxing District? Has this deductir
other county on.property for
in Indiana? ❑Yes ❑No current year? LI Yes LI No
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(iriciuding 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 C my Auditor County Date(month,day,year)
::‘.../6
I I We certify under t e penalty of perjury tha't 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(owners ) Date(month,day,year)
4
Full residen ddress of appli nt(numb=and street,city,state,and Z/•.de)
iiir
7\ %.c A' e, .., .__ _....• _i-i:___-_I-, t 901
Person authorized by my xecu ed Power of Attorney or. C.-1.1-12-0.7 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.