HomeMy WebLinkAboutMortgage_Houchins (6) +47•� f. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year ,
, �� FOR DEDUCTION FROM ASSESSED VALUATION /�
go-', State Form 4570a(R 14/1-20) (_
Form rind with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought.
G3"Ealxrty Auditor
Must be Iliad or postmarked with the County Auditor or County Recorder of the county*Awe the property is
located on or before January 5 of the calendar year in which the property truces am first due and payable. 0 County Recorder r�1
See reverse side for additional instructions and qualifications. 4,
V
Applicant(owner or contract buyer-see raafrfcfions on reverse side) r
effect---0 4 Ar1Cii Pact- t t6vCAfi7t --- '�V�
Taxing District� Key number/ description R n rrrQaL P,a�g+e�nu/m�betrr }''�
A.a..ew vow a nor i ei ti es of c7�p- 3 30Mortgage/Contract indebted indebtedness
urea.Awes of - 4/es of i-s t he e �„'Y a7 V
isPicent net twin—
assessment data,current year assessment date.current year legs/or square/it owner?
'0crl ,.,$3?, liet Cipel ❑No
If no,whet is his/her enact anars of interest? If owned with someone ddhh i then spouse plicate with whore
a items on record is different than that of applicant,makes.below'. Is the in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
•• ••.." FILED
n �Gdex-�1 C're �y�.�
Address of mores mrltraG scion inrrrrMrer and repot,dry stele,and ZIP coda)
Name of assign.e or other owner or holder of mortgage FEB''2$ 2022 ,,
Address at imagine*(number and street city,stale.and ZIP code) y V
If yes,what county? What Taxing District? Has this cede st I rGrsrcorl2r'I of deduction
lea �No cavrentr� rl C �Y AUDITOR
A person is not*refitted to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in Me county
recorder's office(inducfiny any home equity line of credit that is recorded M 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 M my '/{' County Date(month,day,r+rM
Ault �';bso n araara a. _.
I/We certify under the penalty of perjury that the above and foregoing Information 1s true and correct and that the applicant Ili a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
} an
or . tit j�a .,' .a
CO
as a
Fall resident address at (number sheet ctfy,style,and ZIP coda)
totrq-r 5 rt Ave, tea. r-,tit ..� 51763q j
Pen
ton aufhoread by duly executed Paw Attorney or oy IC 6-i.1-12-0 7 Date(month.day.yea.)— �) I
Address of authorized parson (number end street,dry,stale.and ZIP cods) --M^- ...,
«-,�- is,.....)
The penalties for perjury can include imprisonment up to two end a half years and a fine not to exceed$10,000. t
_ _ _ N RECEIPT fOR FLING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Warn.of ! �Al `1 '/ �r � \dw,,.r 1 . A/1pr (a. Eckic'll/15 0,r t -4 F-t Li.ad (N cc a saint Ci vi_ c::
Dale�(3r3 �� Taxing District
wag � 3s act w —
Kay number/legal description
.26 M1'/Iy�l'T f� -34-3m-ca D NI-c q
�� County
W / County ---
D.b( YY �[:XL oY/ PIL
.ED
FEB .2 2 2022 , --, /'
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