HomeMy WebLinkAboutMortgage_Coleman (2) .. n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Cr FOR DEDUCTION FROM ASSESSED VALUATION DUL"ENTERED FOR TAXATION
State Forth 43709(R12 1 6-14)
�� Prescribed by Department of Local Government Finance
Subject to final acceptance for transfer
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INSTRUCTIONS: MILMIl iii•
To be filed in person or by mail. II • Ifl;h: j-'
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. I --!— CC��,,1��for
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pr.•:re - �IT4Ij�•%i County�(ipp�aurtUf
located on or before January 5 of the immediately succeeding calendar year. UN 3conti bon County
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of ft-604y rder
where the property is located during the twelve(12)months before March 31 of each year the deduction is s. • .
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Coleman , Michael L. GIBSON COUNTY AUDITOR
Taxing District Key number/legal description Record number Page number
Princeton 26-12-07-401-000-745.020/Pt SE 7-2-10 .35A / 07(73)-
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as c`.• Is the applicant the sole
March 1,current year March 1.current year date of application legal or equity owner?
103,400 92,000 113,110 Dtires ❑ 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 perty in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
1st Alliance Lending, LLC
Address of mortgagee or contract seller(number and street,city.state,and ZIP code)
111 Founders Plaza, Suite 1300, East Hartford, CT 06108
Name of assignee or other owner or holder of mortgage (� c
Address of assignee(number and street.city,state,and Z/F ` '\ �r'—t\1 L. C W it.. N .
Does applicant own property in arc If yes,what county? �� `Sjk ` ` ``\G-Y�i �Q en requested If yes,state amount of deduction
other county ,`,p,
in Indiana? ❑Yes No at. `c _ -aL3) t✓Yes ❑No
A person is not entitled to this deduction unless the p Tact indebtedness that is recorded in the county
recorder's office(including any home equity line of a ZS' \ 1'3 \\O , U 0 rt is the 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 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 nor ) Date(month,day,year)
Full resident address of applicant(number and street,city,state.and ZIP code)
IOU CI MMY11 S4 . rr;nccJcA in) 417(070
Person authorized by duly executed Power of Attomey or by IC A-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
FIL'111 it
The penalties for perjury can include imprisonment up to two and a hall years and a fine not to exceed 510,000.