HomeMy WebLinkAboutMortgage_Scott (11)� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS � Couni
�° FOR DEDUCTION FROM ASSESSED VALUATION
`t " 4
���t State Form a37o9 (Rn / 6-09) Gibson
�' PresrnheC by Department of Local Govemment Finance
�TRUCTIONS: �
e filed in person or by mail.
rding Dates: i) Real Pmperty: Musf be completed and dated in the calentlar year tor which tM1e deduction is sought.
Must be filed vnth the CountyAUditor or County Recorder o7 the county where the property is lowted
on or 6efore January 5 of fhe immediately succeeding cafendar year.
2) Mobile /Maw(acNred Homes nof assessed as Real Property: Must file vnth the CountyAUditor of (he
munty �ihe�e the property is located dunng the tweWe (12J months before March 31 0; each year the
deduction is sought �
See reverse side /or additional instructions and qualifications.
App6ram (owner w contract buyer - see resMclions on reverse side)
Randoloh W. Scott
Year
Washington � 2012
e
filed
3�J
County u I:or
`� � ZB��nty Recorder
C.'�.fh-�-_. .
Taidng DistriC. Key number / legal description Recortl number Page number
Gibson 26-OS57-104-000.961-017 ��.01a 343`�
Assessed value of real property as of Mortgage / ConVact indeEtedness unpaid as of Mortgage / CrnVaci intlebledness unpaid as of Is the applicani ihe sole
Mard� 7, wrtent year March 1, curtent year tla�e of application legal or equitable owneR
36.200.00 0.00 49,795.00 ❑� Yes ❑ No
If rro, H�hat is his / her exacc s�are of interest? 1( owned �Nth someone other ihan spouse, indicate with whom
If name on recorA is diRerent ihan �hat of applicanl inEicate belov.^ Is the pmperty in question: Annualy Assessed
�❑ Real Property ❑ MnuallyAssessed
Mobile Home fIC G7.1-i
Name of mortgagee or mnvact seller
Top Flite�Financial, Inc.
Address of mortgagee or contraG seller (numberend sUeef. cit}; stafe. antl
123 E. Grand River Avenue, Williamston, MI 48895
Name of assignee or oNer ovmer or holder of mortgage
AOOress of assignee (number antl stree(.
applicant am p�operty in any other
y in Ind"ana? n Yes
siate. arrd ZIP code)
No
county? I What Tadng Distntt? I Has Nis dedudion been requesteE on pmperty
for curtent year? ❑
❑ �'es �
COUNTYAUDROR
DetluGion approved in Ne amaunt of:
20 20 _ 20 _ 20 _ 20 _ 20 _ 20 _
Signawre of CounryAUEtw Cwn.y Date (mrn1h, day, year)
II I We certify under the penalry of perjury that the above and (oregoinq information is we and cortec[ and that ihe applicant is a resident of indiana and
owner / conVaci buyer of lhe aforementioneG property on date applicalion is filed.
Sigrature (own s(u0 nam ) Date (mcnN, Gay, year)
�. � � 7/16/2072
IFuA resident adtlre � ot appL nt (numGer antl sbeet, cRy, stale, anC ZIP cotle)
4662 N. SR 65, Patoka, IN 47666
Person au�M�izeC by Cuty ezecutetl Pmver ot Anomey or by IC F7.142-0] Dace (month, tlay, year)
Address of au'.horized person (n�mber arH sbeet, city. stale, and Z!P cotle)