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HomeMy WebLinkAboutMortgage_Brusie r• °a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count • W. I_ Year FOR DEDUCTION FROM ASSESSED VALUATION 'i s 6• ` State Form 43709(R12/614) Gibson , 1lod go xj. ) 4 Prescribed by Department of Local Government Finance ,�" INSTRUCTIONS: r " r To be filed in person or by mail. Form ile•wi I h: Filing Dates: 1) Real Properly: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 property is •©,Co y, Au." •r located on or before January 5 of the immediately succeeding calendar year. I... gq^.th';L Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of tie C where the property is located during the twelve(12)months before March 31 of each year the deduction i rC:'. o • I. • - - See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Nicholas F. Brusie Taxing District Key number I legal description Record nu{nber Pag);rt , I Montgomery 26-17-32-100-004.310-021 ,? 1J /IJ Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpai as of Is the applicant the sole March 1.current year March 1,current year date of application legal or equitable owner? 244,600 179,075 DI Yes ❑ No It no,what is Ns/her exact share of interest? If owned with someone other than spouse,indicate with whom 1 If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed fJ Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller USAA Address of mortgagee or contract seller(number and street,city,state.and ZIP code) 10750 McDermott Freeway, San Antonio, TX 78288 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? What Taxing District? Has this deduction been requested If yes,state amount of deduction other county on property for in Indiana? ❑Yes El 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 20 _ 20 20_ 20 20 ISignature of County Auditor County 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. Signature(owner's lull e) Date(month,dal/.year) - > -t _=._ CI Ila14 Full resident address of applicant(number and street,city,state,and ZIP code) 11168 W 1000 S. Poseyville, IN 47633 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) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.