HomeMy WebLinkAboutMortgage_Blye j;p.9. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
d
e FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
+� "• Presuibed by Department of Local Government Finance F EP
INSTRUCTIONS: F �1
To be filed in person or by mail. fled y5
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. J LU t,l
Must be filed with the County Auditor or County Recorder of the county where the property is located ❑ County Auditor
on or before January 5 of the immediately succeeding calendar year. y Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
BLYE MARSHA M. GIBBON COUNTY AUDITOR
Taxing District Key number/legal description R u er Pare)
PRINCETON 26-11-01-404-000.079-028 O� ses
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,current year date of application legal or equitable owner?
ta -CD 12 Yes 0 N
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
Si Real Property ❑Annually Ascpssed
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 RD 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 other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes GI No ❑ Yes ❑ No
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/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.
Si store(owners lull e) Date(month,day,year)
Full resident address of applicant(numbe nd street,city.state.and ZIP code)
520 W GLENDALE ST PRINCETON IN 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)
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