HomeMy WebLinkAboutMortgage_Chapman�• "'na STATEMENT OF MORTGAGE OR CONTRACT I �LW�!d• ES o t Township Year
;�s._, 4 FOR DEDUCTION FROM ASSESSED VALUATI� p►1 �
"�.�' State Form 43709 (R77 / 6-09) y ibson Ft. Branch
'�,—; 'T Prescnbed by Departmem of Local Govemment Finance
INSTRUCTIONS: NOV S 2� File Mark
To be �led in person or by mail.
Filing Dates: 1 J Real Property: Must be completed and dated in fhe calendar yearlor which 16e�ae uc � ht.
Must 6e filed with the Counry Auditor or County Recorder of the county where fhe prope s t�R
on or before January 5 07 the immediately succeeding ca/endar year. GOUNTY A
2) Mobile /Manufactured Homes nof assessed as Real Property: Must (1�4$r��ii�WUnty Auditor ol the
county where the property is located dunng fhe twelve (12J months be/ore Ma�ch 37 0! each year the
deduction is sought.
See reverse side 7or additional instructions and quali(ca6ons.
Fortn filed with:
� CountyAuditor
❑ County Recorder
Applicant (owner or conUac( boyer - see rasfic(ions on reverse side)
Mary Chapman
Taring Disirict Key number / legal descripfion Record num6er Page number
Ft. BranchTownship 26-19-18-303-000.825-026 Pt Lots 138 & 139 Genung & Walters Add. �Q� 57']
Assessed value of real properry az of Mor.gage / Contract indebtedness unpaid as of Mortgage / ConVact indebtedness unpaid as oi Is the appliwnt the mle
March 1, wrrent year Mamh 1, wnent year date of application legal or equitable owner7
71,200 ❑ Yes ❑ No
If rro, what is his / her exact share of interest? IF owned with someone other Nan spouse, indifate with whom
If name on record is diRerent �han that of applifant. indicate below. Is the pmperty in question: Mnualty Assessed
❑ Real Property ❑ MnualtyAssessed
Mobile Home (IC G1.1-7)
Name of mortgagee w contract seller
American Financial Resources Inc.
Address of mortgagee or conVad seller (num6er and s[reet, city, state, and ZIP code)
9 Sylvan Way, Parsippany, New Jersey 07054
Name of assignee or other owner or holder of rtrongage
Aadress of assignee (number and street city, state, and ZIP code)
Does applicant own properry in any other If yes, what wunry? What Taxing District? Has this deduction been requested on pmperty
county in Indiana? O No for current yeaY.� � yes
❑ Yes ❑ No
iction apprrned in the amounl oC
20 20
Signature of Counry Audi:or
COUNTYAUDITOR
20 20 20
Counry
20 20
Date (monfh, day, yea�
I I We certify under the penalty of perjury ihat the above and foregoing information is true and correct and Ihat ihe applicant is a resident of Indiana and
owner / wnUact buyer of the aforementioned property on date application is filed.
N resideill addre ol a�nt (number And ureef, city, state, and
306 E Walnut t. Fo Branch IN 47648
Person authorized by tluty exewted Power of Attomey or by IC &7.1
person (number and st2et. uty, state, and ZIP cotle)
Date (month, day, yea�
iinizo�z
Date (month, day, year)