HomeMy WebLinkAboutMortgage_Shaw (2) AISTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e_ _y ; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14) FILE
- Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. IIIII Q 2U15 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deductio�H§Ought. J
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. r ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coun j,•;"1 .•.�d;,14,i uty
where the property is located during the twelve(12)months before March 31 of each ve; • - .. j l Y .J o t. R
See reverse side for additional instructions and qualifications. to I D
Applicant(owner or contract buyer-see restrictions on reverse side)
Shaw, Charles A. & Gloribeth P.
Taxing District Key number/legal description Record number Page number
Princeton 26-12-18-103-001478-028/PT NW18-2-10 .38 AC X6/5 a F/9
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,anent year March 1,current year date of application legal or equiiyble owner?
13100 133536 es ❑ 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 deferent than that of applicant,indicate below: Is thejw.perty in question:Annually Assessed
geh'eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
American Mortgage Service Company, •
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
11503 Springfield Pike, Cincinnati, Ohio, 45246 - -
Nameofassigneeorotherownerorholdero f mortgage "St °Ur — `a.S ,y
Address of assignee(number and street,city,state,and ZIP code) _ r� ��ni ,
Does applicant own property in y If yes,what county? What Taxing District? Q Q _ _.ate\ ,l t S C tuedon
other county r3'4 ��S
in Indiana? ❑Yes No _ /
A person is not entitled to this deduction unless the person has a balance on the person': 'f` \- 153 L • O (-) e county
recorder's office(including any home equity line of credit that is recorded in the county re —1.— _ 1
COUNTY AUDITOI
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 I contract buyer of the aforementioned property on date application is filed.
Si noyt�� ners fu name) D�(month,day,year)
((///,yr/'�,..tr��Q/(/!,g 66 —2-3— /5-
Fu, si ent addrES§of applican (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 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$10,000.