HomeMy WebLinkAboutMortgage_Fidler (5) a�„-_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _,,,may Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R12/6-14) •,
Prescribed by Department of Local Government Finance '
INSTRUCTIONS: t rt %OW) File Mark
•To be filed in person or by mail. QC 1 1 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 .here the!• ••-j- is B County Auditor
located on or before January 5 of the immediately succeeding calendar year. Q�°'r'�r��TOR ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cou '.'t•= • .+ •-µawry
where the property is located during the twelve(12)months before March 31 of e 0, .1 ion is sought.
See reverse side for additional instructions and qualifications. Gtb°” - ,_
App(cant(owner or contract buyer-see restrictions on reverse side)
Rachael L Fidler
Taxing District Key number/legal description Record number Page number
,fit-121eD-3oL1-otoz. 16Z-026 Brixid it ITh(pc ;Cult.- M2 o1
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contrandebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
.O 1p I ID 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 different than that of applicant indicate below: Is the property in question:Annualy Assessed .
GI Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Hallmark Home Mortgage, LLC
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
7421 Coldwater Road Fort Wayne , IN 46825
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 , property for
in Indiana? Yes MI o current year? ❑Yes FA No
A person is not entitled t• 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 0. 'act buyer of the afor-mentioned property on date application is filed.
' i Da:e,impn :9ea�/6
re.dent address p.(cant( umber and street,city,state,and ZIP code)
211 Delaware Street Princeton, IN 47670
Person authorized by duly executed Power ofAttomey 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 510,000.