HomeMy WebLinkAboutMortgage_Yancy i^•�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township I Year
°a__,.y FOR DEDUCTION FROM ASSESSED VALUATIO I
` State Form 4by 9(P12/6-14) 1 L E Dibson ?0.{Tjk� 2014
Prescribed by Department of Local Government Finance 1 I11 IL/p
INSTRUCTIONS: File Mark
To be filed in person or by mail. A G i 2014 Form fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar y:. 4 �i ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file U: : ■rig tart": itor of the county
where the property is located during the twelve(72)months bet%160 V'F - -• AIj o*is sought. --
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) „
Daniel S and Charlotte M Yancy t,.. "x"
Taxing G i son Key number/legal description - R ca n •�
Gibson 126-11-15-100-003.803-027 I(.
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is a applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
104600 87140 96715 M Yes ❑ No
I If no.what is /her exact share of interest? If owned With someone other than spouse,indicate with whom
._x
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑. Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
First Guaranty Mortgage Corporation
Address of mortgagee or contract seller(number and street.city.sare.and ZIP code)
. 1900 Gallows Road, Suite 800, Tysons Corner, VA 22182
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 If yes.what county? I Wnat Taxing District? Has this("eduction been requested If yes.state amount of aeduction
other on property for
in Indiana? Yes I,]No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
•
20 20 I 20 1 20 20 20 20
I Signature of County Auditor I 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 the aforementioned property on date application is filed.
Sip re(ow me)l Date(month.day.year)
/�f �de � -� - 6/20/2015
u1F I resitlent address of ap� am(nun r and sheet.city state,and ZIP code)
615 South Bar Lane, Princeton, IN 47670
Person autnonzed by duly executed Power of Attomey or 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)
- The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S 10,000.