HomeMy WebLinkAboutMortgage_Dilbeck ,,c,. v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1 .. FOR DEDUCTION FROM ASSESSED VALUATION 2016
t3'` ,l` State Form 43709(R12/6-14)
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Prescribed by Department of Local Government Finance File Mark
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INSTRUCTIONS: �}
To be filled in person or by mail. Fdrm:fded 1q.
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 JUN 2i 8 ZQ 16County Auditor
property is located on or before January 5 of the immediately succeeding calendar year.
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ❑ County Recorder
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. G I8 Sr1.j r CU
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Applicant(owner or contract buyer-see restrictions on reverse side) - AUDITOR
Tiffany Renea Dilbeck and Jarrett L. Coberly
Tax' District
Key number/legal description 26-11-14-101-000.557-027/1802 W Record number Page number
7(/ Cambridge Place, Princeton, Indiana 47670 ' 67 . 5 '7 7
Assessed value of real prope 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 leg or equitable owner?
$94,000.00 , es ❑ No
If no,what is his I 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: - — - I lc the nrooertv.inpuestion: Annually Assessed
ssessed
l(1 (IC 6-1.1-7)
Name of mortgagee or contract seller
Caliber Home Loans, Inc. Drawer NO
Address of mortgagee or contract seller(number and street,city, state,and ZIP code) • ^ �
' 3701 Regent Blvd. Suite 180, Irving,TX 75063 Card NO, O`/
5 3
' 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 lin any If yes,what county? What Taxing District? on Has property is ddfuction been requested If yes,
deduction
amount of
other county
in Indiana? ❑ Yes No ' current year? ❑ Yes ❑ No
A person is not entitled to thi 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:
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/contrad buyer of the aforementioned propert on date application is filed.
S' atur o`al uff nary v Date(month,day,year)
Full resident a 1 Tess ofap� licant(number and street,City,state, and ZIP code) ( (
1802 W Cam ge- lace, Princeton, IN 47670
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.