HomeMy WebLinkAboutMortgage_Kenworthy ems' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.a ,, FOR DEDUCTION FROM ASSESSED VALUATION
State Fond 43709 art l/6-09) FQ
"> Prescribed by Department of local Government Finance R9O
INSTRUCTIONS:
To be filed in person or by mail. Form 6 with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.NU V 4 i3
Must be filed with the County Auditor or County Recorder of the county where the property is located - County Auditor
on or before January 5 of the immediately succeeding calendar year.
Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of Ipe
county where the property is located during the twelve(12)months before March 31 of each year th lYIYM
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Kenworthy, Chaz Michael
Teti n;xui-r Key number I legal description Re number Page number
F+ S" C� 26-19-18-302-000.854-026 I / zz—(0o12•
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is th applicant the sole
Mardi 1,anent year March 1,current year date of application legal a itable owner?
112,917.00 I Yes ❑ 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 e'property in question:Annually Assessed
Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
First Choice Loan Services Inc. ISAOA/ATIMA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
500 Campus Drive,Suite 102,Morganville, NJ 07751
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? for current year?
❑ Yes ❑ No 1 ❑ yes ❑ No
I
COUNTY AUDITOR I
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County I Date(month,day,year)
II 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 I contract buyer of the aforementioned property on date application is filed. I
Signa e Br's full rame) I Dal do th da ea
Fu rend rat rid 5a of/f/pliwnt(number ands e.and ZIP Code) : U f
rec e ,- cc,�r. + 4_,
(�ra��k,o�,l , u$
Person auth razed by try executed Power of Adomey o by IC 6-1.1-12-0.7 I Date(month,day.year)
Address of authorized person (number and street,city,state,and ZIP code)
•