HomeMy WebLinkAboutMortgage_Johnson (18) y qi STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RI3/10.15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: 11 File Mark
To be filed in person or by mail. SEP 01 2016 Form filed with:
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 prop ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ��IL�y/���y���{y1• ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CourlW�rot+o/7er'���j{G(�
where the property is located during the twelve(12)months before March 31 ct 6O1d N,al6ir1 e. k) tPR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Stephen D. Johnson
Taxing District Key number/legal description Re r m rr Page nu ber
Patoka 26-12-06-203-001.308-028
Assessed value of real property as of Mortgage/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?
$240,640.00 ❑ Yes ❑ No
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
II name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sever
USAA Federal Savings Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
10750 McDermott Freeway, San Antonio, TX 78288
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 in any 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 ❑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/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 flied.
Signature(own ll name) ^ Date(7.lay\y-t I(4)Full resident address of applicantt((number and street.city,state,and ZIP code)
502 Zimmerman Dr, Princeton, IN 47670
Person authorized by duly executed Power of Attomey or by IC 61.1-12-0.7 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.