HomeMy WebLinkAboutMortgage_Rodgers STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
set FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R1216-14) Gibson Ft.Branch
�� Prescribed by Department of Local Government Finance �Fiie �{k rie
INSTRUCTIONS: N
To be filed in person or by mail. Font filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought. rrr��7777]1
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propertH C 1 LJ 'runty Auditor
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 hvetve(12)months before March 31 of each year the deduction is 4 ght.
See reverse side for additional instructions and qualifications. / • 7�nt/jj;
Applicant(owner orconwact buyer-see restrictions on reverse side) (JIBS() COUNTY AUDITOR
Philip Rodgers and Kathy Rodgers
Taxing District Key number/legal description Record number Page number
Ft. Branch 26-19-18-304-000.728-026 (p-50(o 1
Assessed value of real property as of Mortgage/Contract 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?
$70,000.00 El 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:Annually Assessed
El Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Royalty United Mortgage LLC
Address of mortgagee or contract sever(number and street.city,state,and ZIP code)
7999 Knue Rd. Suite 300 Indianapolis, IN 46250
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state.end 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 ❑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 •- ally of perjury that the above and foregoing information is true and correct and that the applicant is a resident cif Indiana and
ow r I contract buyer•f eat. -mentioned properly on date application is filed.
Si. - ..(o toil am> Date(month,day,year)
-s
far • iA 11/11/2016
Full =.'•ent add : of applicant(nu : and street.city,state,and ZIP code)
810 E. Strain St. Ft. Branch, IN 47548
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 510,000. c I LED