HomeMy WebLinkAboutMortgage_Halbig (5) Wiz:;, STATEMENT OF MORTGAGE OR CONTRACT INDEBT-I TownshipYear
:,� ' t FOR DEDUCTION FROM ASSESSED VALUATION O-
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Slate Fbrrn, r.5(R, I 1-20j r" d
r` .Prescribed by Department of Local Government Finance
NOV 2 4 2020 File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form led with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is 2 ght. ri County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the co. ,t ill iy ! �,-rty is
located on or before January 5 of the calendar year in which the propertye�r : :Vabl15 I TO R ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buy r-see restrictions on r verse side) ,
(rep[ M. fta L J re-(sel (� (fodlo► —,- /w
Taxing District Key number/legal de cri tin Rec number Page umber
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage i Cont/act indebtedness unpaid as of Is the a plicant the sole
assessment date,current year assessment date,current year date of application legal or qu' le owner?
—7) OQO co es ❑No
If no,what is his/her exact share of Interest? If owned with sometine other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. e property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgageeora contract seller p/y (� /� ( J
vl r N V ) I I< �L l/t.L/Y t e,rs- P 1_�-(
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti en requested If yes,state amount of deduction
other county on property for
in Indiana? El Yes ❑No current year? es El No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ntra t 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 1 20 20 20 20 20
Signature of County Audito ,ittC...--- County Date(month,day,year)
I I We certify under th 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 plication is filed.
Si,;::ture(ow er's full ame) Dat o
f,,0 )
tr ull resident address of epplican umber end st ,city,stake,a IP code)
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 penury can include imprisonment up to two and a half years and a fine not to exceed$f 0,000. ,