HomeMy WebLinkAboutMortgage_Collins (15) :ACT INDEBTEDNESS County Township Year
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ti _i_--s (J 1_�me S File Mark
/NSTRUC `J2 Form filed with:
Sl �" T /�"d[„�95 Dr which the deduction is sought. �r ty
Filing Dab ���111 g dun Auditor
unty Recorder of the county where the property is
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mg District KeysurI-0/legal - -7 - a--
— Record number(Lk P number
Assessed value of real property as of Mortgage/Contract indebtedness unpaias of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application A� r� �� legal or eequittabl�.owner?
c� 0v . �Wz' ❑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 pr in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of`mortgagee
Ci.-Y- or contract seller J\ 6 /J C L E D
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage MAY 2 2022��
Address of assignee(number and street,city,state,and ZIP code)
)2u./ L a,..f/k &rta)
Does applicant own property in any yes,what county? What Taxing District? Has this deduction been 044 CIp,IdN lMeAkiltWrIaIaeduction
other county ,moo n n on currentprn yearty for
in Indiana? ❑Yes O `�(','! year? s ❑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 County Date(month,day,year)
X \1 �� 9 a _ \ o.�:- ;. C,i Ire . c�- -�
I/We certify under the penalty of perjury that the above and foreg ng I rmation 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.
Signature(owner's full-name)e Date(month,day,year)
)( � Uw (c��,_ QQQ ^ oD — e�2-
Full resident ddr`esss(of applicant numb nd street,city,state,and ZIP code) �1 C`=-��\ \ - `�_
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Person authorized by duly executed Power of Attorney or by IC 6-1.1•-.12 0.7 ) + _-' Date`(moth,day,yyeelar►)`Jl
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.