HomeMy WebLinkAboutMortgage_Krohn a//y;�p STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
C� FOR DEDUCTION FROM ASSESSED VALUATION
State Fom,43709(R12/6-14) Gibson 1 Haubstadt
V Prescribed by Department of Local Government Finance en' : :m.„ •a.
INSTRUCTIONS: • ii:i �.P..
•To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought. n 22�11
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the property is AUG G y-1 cffri5Auditor
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 sough
See reverse side for additional instructions and qualifications. r. ' 4117111:
Applicant(owner or contract buyer-see restrictions on reverse side) II x .•UNTY AUDITOR
Brittany M. Krohn and Brandon L. Krohn
Taxing District Key number/legal description I Record number Page number
Haubstadt 26-19-31-400-000.699-009 iok 5 — 3 Vi
Assessed value of real p,uye,ty 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?
$174,154.00 13 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 Is the property in question:Annually Assessed
0 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Hometown Lenders LLC
Address of mortgagee or contract seller(number and street,city.state,and ZIP code)
310 Bridge Street 4th Floor Suite A Huntsville, AL 35806
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? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county „ property for
in Indiana? Yes No current year?Indiana? ID Yes ❑No
A person is not entitled to this deduction unless the person has a balance 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:
20 20 20 20 20 20 20
Signature of County Auditor County I 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.
Signature(owner's fill name) Date(month,day,year)
�,4 Z- (C2_ 07/29/2015
Full resident address of applicant(number and steel,city.state,and ZIP code)
205 S. Sixth Ave. Haubstadt, IN 47639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I 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 510,000.