HomeMy WebLinkAboutMortgage_Egli ..,07:'•i STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
A-_. FOR DEDUCTION FROM ASSESSED VALUATION
\, � ./ State Form 43709(R12/614) Gib i rt I 2016
\ / Prescribed by Department of Local Government Finance D, ,
INSTRUCTIONS:
To be filed in person or by mail. Form fit
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
JUN �¢
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property i.' ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. • c• n c: •rder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the coup LL•
where the property is located during the twelve(12)months before March 31 of each year the deduction is .0. .. p•Th'er
See reverse side for additional instructions and qualifications. GIBSON C(111NTY AUDITOR
. Applicant(owner or contract buyer-see restrictions on reverse side)
Kevin T. Egli and Brooke C. Egli
Taxing District Key number/legal description rd r Pagan n r
Gibson 26-19-18-301-000.079-026 O�
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 ap SKation legal or equitable owner?
129,700.00 0.00 /p' 7 9r/ p Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone otter than spouse.indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Q 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? I What Taxing District? Has this deduction been requested If yes.state amount of deduct on'.
other county on property for '
in Indiana? ❑Yes GI No current year? ❑Yes 151 No ,
A person is not entitled to this deduction unless the person has a ba lance on the person's mortgage or contract indebtedness that is recorded in the county .
recorder's office(including any home equity fine 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:
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20 I 20 20 20 I 20 20 20 —
Signature of County Auditor I County I Date(month.day,year)
I/We certify under the penalty of perjury that the above andforegoing 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.
gnat (owner's full norryrye�) Date(month,day,year)
C - c 5/15/2015
Fu I resident address f applicant(nu ber and street,city,state.and ZIP code)
400 East Sinclair Street, Fort Branch, IN 47648
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 lb exceed 510,000.