HomeMy WebLinkAboutMortgage_Randell Sr �o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
444 = FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
�. f, Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: ■
To be filed in person or by mail. 1 .0 y Chi
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sou _ '.
Must be filed or postmarked with the County Auditor or County Recorder of the county where th p +t+ - 1 Zr -aunty Auditor
located on or before January 5 of the immediately succeeding calendar year. [I County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the f -(T)
where the property is located during the twelve(12)months before March 31 of each year the deduction ght.9 (1
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) / .)
'
Randell, Jon E., Sr. • , :rm. o
Taxing District Key number/legal description GIBSO '.el?�� ' 9e RJnter
Barton 26-20-14-200-001.864-001/PT NE NE 14-3-9 .60 a / (—I)
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,current year March 1,current year date of application legal or equitable owner?
79,200.00 0.00 82,000.00 a-Yes ❑ No
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with wham
If name on record is different than that of applicant,indicate below: krproperty in question:Annually Assessed
en eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
American Financial Resources, Inc. ISAOA/ATIMA
Address of mortgagee or contact seller(number and street.city,state,and ZIP code)
9 Sylvan Way, Parsippany, NJ 07054
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own roperty in any If ea.„what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? [J 04 ❑No k brS0 A. current year? - V09 ❑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 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.
Signal re(owners tue n Date(month,day,year)
dot M1 ��, -rib,----.O(5.
Full rest d�d;gss of app}�`vcan�nt/(�'/nl���umy�an7,c�y,Late,aP \ L -/ /�
Person authorized by duly executedPower of Atromey or by IC 6-1.1-12-0.7 `Daa(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.