HomeMy WebLinkAboutMortgage_Frederick (5) ,��R-,, STATEME -n / / lTEDNESS County Township Year
° tL FOR DEDI F/--J C� cm-kiks/I,
7 P 0� State Form 437C
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File Mark
INSTRUCTIONS: To be file /
��v/ U//7/ Form filed with:
Filing Date: Form must t 'uction is sought. ounty Auditor
Must be filed or postmarked wirn me t_.ounry.vuurur ur .,uta...y..o...,..,�, .rf the county where the property is
located on or before January 5 of the calendar year in which the
Applicant(owner or contract buyer-see restrictions on reverse side) g
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Taxing District Key number/legal description Record number Page number
k:'a t-eri-afT. r a'te--ems- - kqo- C . .. 3c`i$-0 Di . , ,c 1 '1 l 4
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appli nt the sole,
assessment date,current year assessment date,current year dat f app`lication legal stable owner?
I L ` Q 00 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: 1 arty in question:Annually Assessed
R I Pro Annually Assessed
obile Home(IC 6-1.1-7)
Name of mortgagee or contract se er
.\ ,\-e__— APR I g
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) J 2022
Name of assignee or other owner or holder of mortgage C'fBSON`CO C
Address of assignee(number and street,city,state,and ZIP code) V~T Yf1 OD�0
R
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction en requested If yes.state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? Yes ❑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(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 20 20 20 20 20
Signature of County Auditor • � Cou Date( onth,day,year)
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I/We certify under the 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 application is filed.
Si nat,,r6 ner's II nam Date(month,day,year)
tl resident a d ess/of_applica (numb rand street,city,st8,and ZIP code)
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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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.