HomeMy WebLinkAboutMortgage_Osborne <a Ynq STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°,S •4 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form tiled 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 county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County 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)
Osborne, David E.
Taxing District Key number l legal description Record num r Page number
Princeton 26-12-07-402-002.757-028/Highland Home 12 Pt/ 13 Pt f 3059
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant sole
March 1,current year March 1,current year date of application legal or equi a owner?
49,300.00 0.00 40,000.00 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 deferent than that of applicant,indicate below: Is the perry in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mycumortgage
Address of mortgagee or contact seller(number and street,city,state,and ZIP code)
3560 Pentagon Blvd., Suite 301, Beavercreek, OH 45431-1706
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 If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes No ' • _current year?_ ❑
❑ Yes ❑No
A person is not entitled to this deduction unleee rti°^^^" -" ' ' contract indebtedness that is recorded in the county
recorder's office(including any home equity I )that is the basis for the deduction.
��'.5....
Drawcr Deduction approved in the amount of: /(����/�1�
20 20 card NO. .. . `-.......
20 20
Signature of County Auditor Date(month,day,year)
I/We certify under the penalty of perjury that tile aoove 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.
Signatme,(pwne! fug n e£ Da: month,day,year), _07
Full resident address of applicant(number and street,city,state,and ZIP code)
Person authorized by duty executed Power of Acomey 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.