HomeMy WebLinkAboutMortgage_Haake ç4 ,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi. Year
FOR DEDUCTION FROM ASSESSED VALUATION _� State Form 43709(R12/6-14) 2016
Prescribed by Department of Local Government Finance F 1 I H., . 11
reie •
INSTRUCTIONS: • • `
To be filled 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. MAR 202 2016
Must be filed or postmarked with the County Auditor or County Recorder of the county where the
property is located on or before January 5 of the immediately succeeding calendar year. n County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ]�+'r WRecorder
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jeffrey Haake
�7/f xin Dis(t/riy�17� / Key number/legal description 26-19-19-103-000.026-026/1010 S Center Record number' Page nu ber
y xN Z. ii-x..�lC i St., Fort Branch, Indiana 47648 dal /0d s
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?
$98,090.00 O 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
(7 Real Property U Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Top Flite Financial, Inc. and or their warehouse lender .
Address of mortgagee or contract seller(number and street,city, state,and ZIP code)
123 E Grand River Ave,Wlliamston, MI 48895
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 Ta: If yes,state amount of
other county deduction
in Indiana? ❑ Yes 0 No
A person is not entitled to this deduction unless the person has a balance o ]�I'a}1'Cl' 10••••'''/• •recorded in the county
recorder's office(including any home equity line of credit that is recorded in /O action.
Deduction approved in the amount of: COU Ca t,d NO- ••`•
20 20 20 20_ 20 20_ 20
Signature of County Auditor County Date(month,day,year)
I I We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
'g azure(ow y full name) / Date(month,day,year)
N� 1'LC/ -Iii-1 lP
ul ens f applicant(number and street,city, state, and ZIP code)
10 S Center St., Fort Branch, IN 47648
Person authorized by duly executed Power of Attomey 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 S10,000.