HomeMy WebLinkAboutMortgage_Scott (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
;a = FOR DEDUCTION FROM ASSESSED VALUATION
t State Form 4b (p /1415)ePrescribed by Department -
of Local Government Finance
INSTRUCTIONS: -Ile _`a /
To be filed in person or by mail.
Filing Dates: 7) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ✓4
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is / ounty
located on or before January 5 of the immediately succeeding calendar year. /Recorder
2) Mobile
he a the ropis located Homes not the twelve(12) Property:before M file with of each year the de of g_counly �_v
where the property is kxzted during the twelve 112)months before March 31 of each year the dedu �^EdIT�
See reverse side for additional instructions and qualifications. CO
Applicant(owner or contract buyer-see restrictions on reverse side) `
KODY J. SCOTT ygUOir
Taxing District Key number/legal description Record number Page crupper
PATOKA TVVP. 26-12-09-104-000.062-027 RP" 02925
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date.current year assessment date,current year date of application legal or equitable owner?
$ 122,637.00 0 Yes ❑ No
If no,what is his/her exact share of interest? If mimed 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
0 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
HOMETOWN LENDERS, LLC
Address of mortgagee or contract seller(number and street,dry,state,and ZIP code)
310 BRIDGE STREET, 4TH FLOOR, SUITE A, HUNTSVILLE, ALABAMA 35806
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dry,state,and ZIP code)
Does applicant own property in y If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes El No 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:
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 of rementioned property on date application is filed.
S' natu (o ers/ua me Date(month,day ear)
07/ /2016
Furl resident a e applicant(number and street dry,stare,and ZIP code)
1712 UTER LAKE ROAD, PRINCETON, INDIANA 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 810,000.