HomeMy WebLinkAboutMortgage_Colbert (2) /�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ``�asiga •
dF1 of Co CD -��..,. ��:•xis
a.-. . FOR DEDUCTION FROM ASSESSED VALUATION
` Slate Form 43709(R12/6-14) EFMIlt4,r135 2016
'�� Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. ith:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year fa which the deduction is sought,i p CO U�YO (�IFT�B
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the 7 r
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must rile with the CountyAudita of the county
where the property is located during the twelve(12)months before Mach 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner a'cons-act buyer-see restrictions on reverse side)
Ernest M. Colbert and Ronda K. Colbert
Taxing District Key number/legal description Redyrop numb Pa ber
Gibson 26-17-01-404-000.427-022 O/D! OCD(3 5&/
Assessed value of real property as of Mortgage I 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.•prication�iz7 l_ p legal or equitable owner?
S89,400 SO ;:a rti,.
0 Yes rl tJo
If no,what is his/her exact share of interest? If owned with someone other than siwouse,indicate with whom
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
2) Real Property ❑ Annually Assessed
Mobile Home(IC 6.1.1-7)
Name of mortgagee or contract seller
American Advisors Group
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
3800 W. Chapman Avenue, 3rd Floor, Orange, CA 92868
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 • on property for -
in Indiana? 'Q Yes 15I No current year? ❑Yes ONo
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 line 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 (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.
S' ature(owner's pi name) Date(month,day.year)
-yes #' C -Pit- S- /4—/5-
Full resident address of applicant(number and street,city,stare,and ZIP code)
204 East Maple Street, Owensville, IN 47665
Person authorized by duly executed Power of Attorney or by IC 6-1.142-0.7 Date(month.day,year)
Address of authorized person (number and streel,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.