HomeMy WebLinkAboutMortgage_Brinker .:�="� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
1,11,1; FOR DEDUCTION FROM ASSESSED VALUATION °�
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State Form 43709(R10/11-08) Gi Fort r
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. JUN 1 2013
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months before March 31 of each year
the deduction is sought. de /1''�/�^k'
See reverse side for additional instructions and qualifications. r 1$$O N COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Faith Brinker
Taxing Distrct Key number/legal description Record number PagarattfrUbleflt
Fort Branch 26-18-13-403-000376-026/S. 1/2 L 1&S 1/2 L 2 West Add 20130000291i4
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
92,900.00 13 Yes ❑ No
If no,what is his I 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
13 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
ERA Mortgage
Address of mortgagee or contract seller(number and street,city.state.and ZIP code)
1 Mortgage Way, Mount Laurel, NJ 08054
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? VI Yes ❑ No �ZC6Qt. for current year? ® Yes p ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 1 20 20 20 20 20 20
Signature of County Auditor County I Date(month.day year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of th aforementioned property on date application is filed.
Signature(owner's full name)1 if n Date(month.day.year)
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Full resident address of applicant(number and street.city,state,and ZIP code)
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)