HomeMy WebLinkAboutMortgage_Crabtree (5) ISTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
q FOR DEDUCTION FROM ASSESSED VALUATION
2 State Form 43709(R12/6-14) Gibson Montgomery 2017
•' ' Prescribed by Department of Local Government Finance
INSTRUCTIONS: File pa�+
To be filed in person or by mail.
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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. MAR 3 0 Dunty 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 so ht.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) GIBBON COUNTY AUDITOR
Dwayne Crabtree
Taxing District Key number/legal description Record u ber Page n
Montgomery 26-18-07-101-000.245-022 / 11
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,adrent year March 1,amen:year date of application legal or equitable owner?
102,300 ✓/ 121,754 i/ El 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
Fl Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Top Flite Financial
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
123 E Grand River Ave., VVilliamston, MI 48895
Name of assignee or other owner or holder of mortgage •
•
•
Address of assignee(number and street,city,state,and— "' \ _ _ _ _ _
O W ot- C (se-\0k e.0 sJ
Does applicant own property litany If yes,what coun '� 1 c- teen requested If yes,state amount of deduction
intrIndlaa?y El Yes IJ No c3P�,11-Ct ` "tiO-`^C1 ._\TIC IYes 0 N
A person is not entitled to this deduction unless U ;tract indebtedness that is recorded in the county
recorder's office(including any home equity liner 1 a 11 S f{ •p b ;at is the basis for the deduction.
Deduction approved in the amount of:
-)-.0 IL —I t�-1 3'�6- lko
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/contract buyer of the aforementioned property on date application is filed.
`Signature(owner's full nq(ne\= Date( onth.day,/ye-ar)
Full re "•e -t•ress o ••(cant(number and street,city,state.and ZIP code) "I
rsts St., Owensville, IN 47665
Person au ' -• by duly 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.