HomeMy WebLinkAboutMortgage_Ott flSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION 5�
Y
State Forth 43709(R11/6-09) 2014
Prescribed by Department of Local Government Finance ` fk
INSTRUCTIONS: JUN 3 0 2014
To be filled in person or by mail. Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located ,l j! unty Auditor
on or before January 5 of the immediately succeeding calendar year. r�16SON CO TY BB rder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of thQ �`U�
county where the property is located during the twelve(12)months before March 31 of each year the
• deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Aaron M.Ott and Danielle M.Ott
Taxing District Key number/legal description 26-19-18-303-000.262.026/302 E Vine St. Record number Page number
Fort Branch, Indiana 47648 �)—J� //�
26-19-18-303-000.262.026 111 /Ott(x'�
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/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?
$102,606.00 axes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whoni
If name on record is different than that of applicant,indicate below: Is the property in question: Annually Assessed
7Real Property ❑Annually Assessed
Mobile Home LC 6-1.1-7)
Name of mortgagee or contract seller -- - — — -
VanDyk Mortgage Corporation /� A 9,0t)
Address of mortgagee or contract seller(number and street I I't
2449 Camelot Ct. SE,Grand Rapids, MI 49546 1 D�tL�-� lop f
Name of assignee or other owner or holder of mortgage / -�
Address of assignee(number and street,city, state,and ZIP i ) f —ill I O g'
Does applicant own property in any other If yes,v; l _ ' _ nas this deduction been requested on property
county in Indiana? for current year?
❑ Yes ,❑,No I ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under 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 the aforementioned property on date application is filed.
,Signature(owner's full n ra , D (month,dad 6
Full resident ad ress of applicant(number and street,city, state,and ZIP code)
302 E Vine St., Fort Branch, IN 47648
Person authorized by duty 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)