HomeMy WebLinkAboutMortgage_Peyton (2) -*.,, STATEM -- - -- .+ skrrmar`T INDEBTEDNESS County Township Year
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FOR DEI /�/ (/1 `— I
.'- State Form 42 V� `J.W�n , a.
%:. Prescribed t Drawer NO
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File Mark
INSTRUCTIONS: To be (® 7 Form filed with:
Card NO. Y e!\ eduction is sought. ®�ounty Auditor
Filing Date: Form I)
Must be fi r of the county where the property is
located of ty taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Ap icant(owner or buyer-see restrictions on reverse side) - ^-(—
Taxing District numberdescription �� �] Record number P number
PC District
- %-31.5
6 ,--- k Q - 1 t -\ - %o t-- 000 —`lc lsz - O 7 c3 F-)a CO
Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is legal or equitable the owner?
sole
assessment date,current year assessment date,current year date of application
11> t LA 0no0 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 the property in question:Annually Assessed
l i-Freal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller A 1-szE T T E
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)Name of assignee or other owner or holder of mortgage AP"'/Q
2,j 202
Address of assignee(number and street,city,state,and ZIP code) G/BSON CO _
Does applicant own pro rty in any If yes,what county? What Taxing District? Has this deduction bee equested MITpe2,5tt ou t of deduction
other county on property for 0/7-
in Indiana? es ❑No current year? es El No O/i,
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 County \ C O� Date(month,to,G,ye�r)I/We certify under the penalty of perjury that the
above and @ire o information i t ue and correct and that the appl`ht is a sident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Date(month,-t( year)
Signature(own full name) -
�C ..� p�
Full reside dress of appli umber and street,city,state,and ZIP code) f� `�n � ` 1
1 9 3 o- '12-0. • i Yi 1 \I`�—\ '
Date(month,day,year)
Person authorized by duly executed Power of Attorn r by IC 6-1.1-12-0.7
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.