HomeMy WebLinkAboutMortgage_Coomer David Jr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
el .,: 4 FOR DEDUCTION FROM ASSESSED VALUATION
6• State Form 43709(R12 16-14) Gibson 2016
a 1 Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
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
Davi(ownerrlm oobuyer-see restrictionscyverse side) 4015noo1.�
David Carl Coomer Jr and Jaclyn N Coomer
Taxing District Key number I legal description R-:- •number Page number
Gibson 26-12-16-400-004.024-027 •/ //d,9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
1369current year March 1,current year dale a lor1„ legal or equitable owner?
136 00 15500 15 /1�[ter p Yes ❑ No
If no, t is his/her exact share of interest? If owned with a 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
p Pro �l An�ua sse(IC 6
I qne-M-{gbi a(IC 6-1.1-7)
Name of mortgagee or contact seller
Hallmark Home Mortgage
Address of mortgagee or contact seller(number and street,city,state,and ZIP code)
7421 Coldwater Road, Ft. Wayne, IN 46825 JAN 4 2016
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city ate,and ZIP code)
GIBSON COUNTY AUDITOR
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 3000
in Indiana? ❑Yes 0 No current year? 0 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
recorders 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
owne contract buyer of the aforementioned property on date application is filed.
•'gn-the(•con lull name) • Date(month,day,yearl
� !iIS,iASA I - 22- h -
Full resident add - of applicant(number and street.city,state,and ZIP code)
2256 E 150 S, Princeton, IN 47670
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$10,000.