HomeMy WebLinkAboutMortgage_Schleter (2) .ter=*e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� '%�,e FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
/21
b.6 4�Lt fb 2ow
""'' State Form by (par/1-20) //1
-��° 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. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-se.e.kestrictions on revere sip), • - ,, I Stkia_tot )
TaxiLiig District Key number/legs description Record number Page number
oa t faxes 2i__12' zn—nip' - 30° 64.Z. 19 /- 'i a v A o 5
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant t sole
assessment date,current year assessment date,current year date of application legal or equit a owner?
7o�coo 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 th roperty in question:Annually Assessed
Real Property E Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of m gagee or contract seller
n Au.e_a___, 1
A ress of mortgagee or contracfseller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage 10`I � �O
Address of assignee(number and street, ' ,state,and ZIP code) 1 V
Drawer 7� `Does applicant own property in a If yes,what county? 1`T0 .0 (.) f raj p� d��dri
other county SUN
in Indiana? ❑Yes No i �N G
A person is not entitled to this deduction unless the person ha Card �1 Q• •• 5`-' ``� ess that is recorded in the county
recorder's office(including any home equity line of credit that ••• ...9......, 'or the deduction.
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signatur of C my Auditor County Date(month,day,year)
A.A.A.---(,)/)114,
/We rtify under the penalty of perjury t.. the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
o r/contract buyer of the aforementi.-; property on date application is filed.
ySignatur w is full n me / 'Date(mont ,day,ye )
.... l!�z 3�ZozD
Full r id address of ppli.-nt(nu..er and street,ci ,state,anct ZIP code)
9Gz .ZS 5 wo eLZ/��9
erson authorized by duly execute 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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.