HomeMy WebLinkAboutMortgage_McCarthy (2) °r o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
54 �4 FOR DEDUCTION FROM ASSESSED VALUATION 2016
State Form 43709(R12/6-14) '^',�'g�
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S� / Prescribed by Department of Local Government Finance fk
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INSTRUCTIONS:
To be filled in person or by mail. Form filed with:
Filing Dates: 1)Real Properly:Must be completed and dated in the calendar year for which the deduction is sought. JUN 6 Q/() b
Must be filed or postmarked with the County Auditor or County Recorder of the county where the
County property is located on or before January 5 of the immediately succeeding calendar year. tY Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the liamectett—C&-mty Recorder
county where the property is located during the twelve(12)months before March 31 of each ye
deduction is sought.
SON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Patrick L. McCarthy and Carolyn M. McCarthy
Taxing District Key number/legal description 26-14-18-403-000.240-007/319 S Gibson Re�/d number Pa a num r
9a /-A si Street, Oakland City, Indiana 47660 l a I
Assessed value of real grope s of Mortgage/Contract Indebtedness unpaid as of Mortgage I 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?
$81,720.00 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
(ZFReal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Open Mortgage LLC -
Address of mortgagee or contract seller(number and street,city,
14101 Hwy 290 W, Bldg 1300,Austin,TX 78737 ��- a a 1�
Name of assignee or other owner or holder of mortgage CA n
Address of assignee(number and street,city, state,and ZIP coo MC u7 QTY, P4 r-2.,E c L
CA/20 t y•✓er1
Does applicant own property in any If yes,what county? en requested If yes,state amount of
other county - deduction
in Indiana? ❑ Yes No I current year? ❑ 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
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:
1 20 20 20 20 20 20_ 20
Signature of County Auditor County Date(month,day,year)
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.
vnaturow me) C C� te(moot�d?ye/`
Full resident address of applicant(number and st city,state,and ZIP code) S 5-
319 S Gibson Street, Oakland City, IN 47660
Person authorized 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.