HomeMy WebLinkAboutMortgage_Wallis (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
b _ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/614) Prig _ Fovrl 2017
,,,„ Prescribed by Department of Local Government Finance 1101 s 1 II11���
INSTRUCTIONS:
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To be filed in person or by mail. Fojm toed with:
Filing Dates: I) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. SE P 15 2LU6
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is L17 County Auditor
located on or before January 5 of the immediately succeeding calendar year. III Caul Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the c• I p
where the property is located during the twelve(12)months before March 31 of each year the deal lion . .- 40rn.:r
See reverse side for additional instructions and qualifications. V IbSON C•UNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Jerry Robert Wallis & Nikki Jo Wallis
Taxing District Key number/legal description Record numker ..,_ 160,ge number
Fort Branch 26-19-19-101-000.698-026 I ID—i8
Assessed value of real property as of Mortgage/Contact 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 legal or equitable owner'?
111,600 112,560 p 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 deferent than that of applicant,indicate below: Is the property in question:Annually Assessed
a Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
('5Kfrc 1 ANtuic,.rl l\C(Ye
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
—1 MC,Y St- j er, 'I& (-Il SLi Lu
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 ny If yes,what county? What Taring District? Has this deduction been requested If yes,state amount of deduction
other county „ 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 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 properly on date application is filed.
Si natu -(owner's r 0 -me - Date(month,day,year)
.v li�,- 7' A - % �� 09/13/2016
Full r:!,•e address of applicant(number and sheet,city,state,a •ZIP code)
5” Willard Street Fort Branch, IN 47648
Person authorized by duty 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.