HomeMy WebLinkAboutMortgage_Michael III 4� STATEMENT
EDUC IO MORTGAGE S D VALU CONTRACT INDEBTED County Township Year
(4i._ '; FOR DEDUCTION FROM ASSESSED VALUP�A.'IQ
• State Form 43709(R12/6-14)
\ '• Prescribed by Department of Local Government Finance
INSTRUCTIONS: 2015 File Mark
To be filed in person or by mail. 3 AN 1 3 L Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deductio is •.•ht.
Must be filed or postmarked with the County Auditor or County Record- •f the .•f m_4f ere the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calend-�if it `tnTih( p� ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must ril• • olyWargrrQt the county
where the property is located during the twelve(12)months be •• ::'"-7,-t • 7 -ach year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner cr contract buyer-see restrictions on reverse side)
Michael, James E. & Kelly L.
Taxing District Key number/legal description Record number Page number
Princeton 26-12-07-303-003.854.028/LE Woods 40/41 / 5 I88
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,cement year March 1,current year date of application legal or egyitable owner?
105,400.00 88,000.00 113,898.00 ,❑ 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 th perty in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Land Home Financial Services, Inc.
Address of mortgagee or contact seller(number and street,city state,and ZIP code)
1355 Willow Way , Suite 250, Concord, CA 94520
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) --
'Y\-1S 1S- 1' —
Does applicant own property in any If yes,what county? What Taxing District? Has a
other county ,—, / on pn ;` M n (� \ —
in Indiana? es ❑No curter 1. uCY-CCU T1Z
A person is no entitled to this deduction unless the person has a balance on the person's mot . I ■ �O
recorder's office(including any home equity line of credit that is recorded in the county record, L • Cr ‘P. tf A�sx\ {f ejt
COUNTY AUDITOR 1 3 1 Q %T .6 U ^°,'v\R°-'.-"-
Deduction approved in the amount of: "•`-•�r'^T`F-°-
20 20 20 20 20 20 20
Signature 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 I contract buyer of the aforementioned property on date application is filed.
Signatuur} wner' full name) Date(month,day,year)
kit( Q/I,'.,,�n /-7-/s—
Full
res' ent�ss 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 stree!,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 510,000.