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HomeMy WebLinkAboutMortgage_Fleming (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year r! � FOR DEDUCTION FROM ASSESSED VALUATION �r ��r�Y�'�rY 7ClZZ �" •;� State Form 137b9(R74!h-20) �� A C `� r" Prescribed by Department of Local Government Finance File Mark INSTRUCTIONS: To be filed in person or by mail. Form filed with. Filing Date. Form must be completed and dated In the calendar year for which the deduction is sought. County Audrtor Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is County Recorder located on or before January 5 of the calendar year in which the property taxes are first duo and payable. �f '1 See reverse side for additional instructions and qualifications. �pb�is '1��`�t f�Applicant(owner or/CConed buyer-see restrictions on PIO s�o�ly�6�J'\ t . `I V �\ ('\�(\� r `��numhe 1��a (, Record number`)/ P nymyyr� Taxing District �`_ J Key numbs 1' 1 de v /lJ i1F—) Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of .I. or appl�nb t the a sole m assessment data,current year essessanl date,anent year date of application g No /2-LZa i`O "Z�tObv "7 t Ord �If no,what is his/her exact share of interest? If owned with someone otherer t than spouse,indicate with whom • �yl'ex 'arc ��� Q..(� - JGY\ tf name on record is different than that of applicant.indicate below: Is the propertpal question:Annually Assessed al Property ElM bile Home Assessed Er) , op Mobile ss 6-1,1-7) Name of mortgagee or contract seller C-cc-N--c...e C_xia ..k \.-\- -,e-, Address of mortgagee or contract seller(number and street.city state,and ZIP code) '(-IN0 Name of assignee or other owner or holder of mortgageY r Address of assignee(number and street,city state,and ZIP code) ,.._ .,i yT A 1 Does applicant own property in any It yes,what county? What Tax' District? Has this deduction bee rapuesteV elir state amount of deduction Taxing on property for !es ®to r4 in d ne? ❑Yes I o current year? 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 racx.eder's office)that is the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount of. 20 20 20 20 20 20 20 County ,s Date(month day,year) Signature of County Auditor / _ -`l— t `�L��c�4 Cam—'�D�--�.� �-.� � v {� �.- - zQ z Z._ I/We certify under the penalty of perjury that the above and foregoing ormat 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. Date(month,day.year) Sig toe(owners p name) I e L' � �4��i�n �0-2-?C L-2, FWI re t address of applicant(number and strew ty state,end ZIP code) 11T1 w Stz �k \- 7 kC - i lu fl(o 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 S10,000. RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS N o/applicant r Name of mortgagee or coot veer Date (month,day,year) ` "An>mllnt of indebted OO�dO Taxi District �! \-��Z Key number/legal de sc ription (( O O° , 'J��r O��. Q Ot —©• J ' Da (month day,year) Signature of County Auditor/County Recorder h / Co"nry/1- T ^— k—_�O 2 - K1 L`�L1�-Q /L Jac 11C n I �>.-� CSC