HomeMy WebLinkAboutMortgage_Shuttle ^�v STATEMENT OF MORTGAGE OR CONTRACT INDEBT Township Year
,a - . : FOR DEDUCTION FROM ASSESSED VALUATION
`. State Form 43709(R12/6-14) I. 1_i���1l A✓ 2016
\ - Prescribed by Department of Local Government Finance I Y�rl NNN V l�l
INSTRUCTIONS: MAY 0.6 2015 File Mark
To be filed 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 or postmarked with the County Auditor or County Recorder of the count j.here t 4•.-..Ai y is III County Auditor
. located on or before January 5 of the immediately succeeding calendar year. 1.,r x li' ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file wit•c• .` • a• •cYhAtblitiTOR
where the property is baited during the twelve(12)months before March 31 •• -.r year he •-•uction is sought. -- -
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Justin E. Shuttle
Taxing District Key number/legal description 'Record number Page number
Gibson 26-04-14-400-000.699-018 ao 15' 1-134-1
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of n/o1licatmn legal or equitable owner?
10,700.00 0.00 /'79Q, /Q• rO 0 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
IZ) Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Hallmark Home Mortgage, LLC
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
7421 Coldwater Road, Fort Wayne, IN 46825
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? 1 What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes 0 No current year? ❑Yes S 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 I 20 _ 20 20 I 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 I contract buyer of the aforementioned property on date application is filed.
ignature(owne's 'I name) I Date(month.day,year)
5/1/2015
Full re ' en dress of applicant(number and steer.city,state,and ZIP code)
4728 North County Road 200 West, Patoka, IN 47666 _
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 sweet.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 310,000.