HomeMy WebLinkAboutMortgage_Burton n t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
3l " State Form 43709(R12/6-14) Gib I g+iau�ctapt 2016
\,,,, , Prescribed by Department of Local Government Finance 19pFlltf.Mtpf �,
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INSTRUCTIONS:
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. FEB 2
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is r I �unry Auditor
located on or before January 5 of the immediately succeeding calendar year. aunt Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co ,) • I❑
where the property is located during the twelve(12)months before March 31 of each year the dedtcljgnfsON/•1 . `tee.
See reverse side for additional instructions and qualifications. nn SS OUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Casey D. Burton
Taxing District Key number/legal description Record number — Page number
Haubstadt 26-19-31-301-000.511-009 ,/ 1 (0 , /7/5-
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?
96,000 7 121 ,200 ,� p 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
Heritage Federal Credit Union O Real Property ❑ Annua!HMs ss 6r1.1-7)
Name of mortgagee or contract seller
5388 Old State Rd 66 P.O. Box 189,Newburgh, IN 47629
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage c
Address of assignee(number and street,dly state,and ZIP cot `'�S e\I J ��`� U
I ` I
Does applicant own property in ny If yes,what county? C'v� 1 \ �b U ' OO guested If yes,state amount of deduction
other county
in Indiana? ❑Yes No a C ` L --' I s ❑No
A person is not entitled to this deduction unless the per's( debtedness that is recorded in the county
recorder's office(including any home equity line of credit - \L .basis for the deduction.
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/ tract buyer of the a rementione(((ddd property on date application is filed.
Si natu (or✓ners ruff nam `I - Date mth,dayya
fill I) IP
r • t add ss applicant(number and street,city,state,and ZIP code) d
112 N. Ine St. Haubstadt, IN 47639
Person authorized by duty executed Power of Adomey or by IC 64.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
I
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed 810,000.