HomeMy WebLinkAboutMortgage_Young (2) e n 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS — County Township Year '
;a_:. 4 FOR DEDUCTION FROM ASSESSED VALUATION
NC State Form 43709(R12/614) FILED
tiy� Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. Form teed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. �9-(�'F
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propei...FEB g U Cgounty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coy
where the property is located during the twelve(12)months before March 31 of each year the deduction i ! ., —.pnii
See reverse side for additional instructions and qualifications. G I RSn N COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
AMANDA RENEE YOUNG
Taxing District Key number/legal description R� np t Pag n
MONTGOMERYTOWNSHIP 26-11-17-400-000.204-021 d `�
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?
$97,553.00 p 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 the property in question:Annually Assessed
II Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract setter
ACCEPTANCE CAPITAL MORTGAGE CORPORATION
Address of mortgagee or contract seller(number and street.city state,and ZIP code)
101 PLAZA EAST BLVD., SUITE 103, EVANSVILLE, INDIANA 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dry,sate,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 on property for
in Indiana? Yes ❑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
recorders 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
Signature of County Auditor County Date(month,day,year)
I 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(o /s full n me) Date(month,day,year)
ime) 01/ 9g /2015
if
resident address of applicant(number street,a 'ate,and ZIP code) L/
1271 S. Old State Road 65, P Inceton, Indiana 47670
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 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 810,000.