HomeMy WebLinkAboutMortgage_Julian ,,,,..F!,:i•-:?.i•-4, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Lc• :
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FOR DEDUCTION FROM ASSESSED VALUATION Year •
StateF 1,4375g P14/1-20 1
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,.:7,z;z-..____ :x• Prescribed bi Department of Local Gowernment Finance
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INSTRUCTIONS To be fed in person or by mai/. FEB 2 4 2022 File Rlark
1 Form Dec!i..vt_h ------;
Filing Date Form 1'P:is'be completed and dated in the cafenda-year for which the-deduction is sought
COI-Irit'Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the 'f' ih'' ere,P.142,-,;-01A'24) -
located on or before JaryJary 5 cf.the ca/e ndan
5 3 -e.9 d•-• `--/* ! 2-0 ,.., / 1 . - .
dale of acct.:scat:on ,,, 1 lep.'ce c:
If rcti-iji:::..-CatS,a;hu•exact ••-•ia-e o'interest? :If 0..--isn,,'..n sittienine other t--,E71 spdluse indicate v,itn,i„-,-,n,
:Is Coe pope.-ty-i-,que.Stic
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I ti n-STeO1Teccr_sti is d ftiee-tte-tire'.c'ace i cant itrisi cate isec,...
E-_-\)_Cri er a 1 Property El
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D-S--,•,:s-abp TiSta.1'.-On-procanyi an:, I l'yes si.tiat CO3-,;,,I, I 1,-.'12...Tariog D strict-% --- Has thi;desj-St, . san recoesteti I I=yes stnt
','.:ts-i‘ed.:cdc';';;;:i r-T Yes' [*N:-) ! . ,Cr property for , I
:cirirent yry.a:-, Yea El No !
A person is no ent,tied trios deduct.en unless the pe,-sen has a be acne co the person's mortgage o °fit 7.1 imiebteCIPOSS that is
rocorders office(inciud,ng an/borne equily line of credit that is recorded in the county recorder's off, -) that 's the basis far the ded:
COUNTY AUDITOR ,:,—C) -----
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23 20 20 20 Is . 20______ I
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I i We cent fy under tie periaty Cl perjury toe'u.e.ab a and forejoing info-mat on is true CO correct and that the app'.ca. is a resHen of Ind era and ------1
owner/contract bu •ar I the aforementioned p,ope,i.y on date appt cation is fled ,
\(,...• S.,. fu,v...05 r. Data Otrpottri day,' year)
pe.,s,_,„.„.,..„..,:z,,..:.,b„ „.....„,executes:Pone-o`Atorc-7-e.,or by-ICC-, 1-,2-C 7 --7 Date(c-nntrt day as-a-,
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Ado-earf cdtt-oszeC.carom r (ri.irriber and street city; state end ZIP
Th.,peneft,es fur perjury cag include impriSOrrrePt up to t",io and a ha't yeas and a fine not to exceed 510.000