HomeMy WebLinkAboutMortgage_Robinson (3) ,.•^^na STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°ems ,� FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14) 26
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To ing Dates:in 1)r Real l by 0 n it•Filing Dates: i) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. a�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property i
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. $ P 2 1 /016
See reverse side for additional instructions and qualifications. ..
Appl t(owner or contract buyer-see reswiCions on reverse side) ^
Ni�las W Mckannan and Jordan L Robinson .,�IJ/e%I
Taxing District Key number 3- description e /,3ft itmprrir,
26-18-13-404-000.051-026, McCrary Etal Pt. Lot 61 �l'jK') `(�llL�J]�T/�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year March 1,current year date of application legal or equitable owner?
• Eyes ❑ 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 Is the property in question:Annually Assessed
GI Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .
Amerifrst Financial Corporation
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
950 Trade Centre Way, Suite 400 Kalamazoo, MI 49002
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 �/l on property for _ 3000.00
in Indiana? ❑ `
Yes Z No current year? 0 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
own/p��/contract buyer-o the aforementioned property on date application is filed.
gn�tL nets h�4 n� / D(I(mAnthl b year)
Full resident address of applicant(number and sweet,city,state,and ZIP code) /(� (-//
205 West Walnut Street Fort Branch, IN 47648
Person authorized by duty executed Power of AttOmey or by IC 6-1.1-12-0.7 Date(month,day,year)
•
Address of authorized person (number and sweet.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. •