HomeMy WebLinkAboutMortgage_North e^r■o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e/ A FOR DEDUCTION FROM ASSESSED VALUATION
S,� •pf, State Form 43709(R11 /6-14) 2015
Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS: i1
To be filled in person or by mail. 11111111 p 4 \5 Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is Lught.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the , u ❑ County Auditor
property is located on or before January 5 of the immediately succeeding calendar year. isilmo' .R1R County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Audi•5 - N1Y AVD) "
county where the property is located during the twelve(12)months before March 31 of each -Fr(t)®V
deduction is sought. GIB
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Kristopher North and Jennifer North
Taxing District Key number/legal description 26-17-01-400-004.385-021 /6792 West Record number Page number
Stonebead Drive,Owensville, Indiana 47665
a-o ) S 3o 30
I 26-17-01-400-004.385-021
Assessed value o real prope f 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?
$196,377.00 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: Ils the prooertv.in nnestu+n-A nn••_LL.-.. .ed
ssed
tS-3 C.37 6-1.1-7)
Name of mortgagee or contract seller —`lR_ \S
Top Flite Financial, Inc.and or their warehouse lender
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 1� .
123 E Grand River Ave,Williamston•MI 48895 �°rt'
Name of assignee or other owner or holder of mortgage '- '1 Cl L :S I" ,6 a
Address of assignee(number and street.city,state,and ZIP code) r
•
Does applicant own property in any If yes,what county? what Taxing District? Has this deduction been requested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes f l No current year? ❑ Yes ❑ No
•
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20_ 20
Signature�off�County Auditor County County Date(month,day,year)
{
I/We certify under 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 afore - oned property on date application is filed.
S•nature(owner' `1l name) - .�/ Date(month,day,year)
• -. .- a•• - s o applicant(numberraand st''1 1%. - - .nd ZIP co) Li
6792 West Stonebead Drive, Owensville, IN 47665
Person authorized by duty 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.