HomeMy WebLinkAboutMortgage_Cooper (4) a�^ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN S C;%j Township Year
t ~ .li FOR DEDUCTION FROM ASSESSED VALUATION
,i-
r State Form 43709(R13/10-15) Gibson Ft. Branch 2017
Off' Prescribed by Department of Local Government Finance ° ./t$
INSTRUCTIONS: Q 1 File Mark
To be filed in person or by mail. .i Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduc is • ;.T,.
Must be filed or postmarked with the County Auditor or County Recorder of the count 41 ; „o":ap�tQo%' ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. o�ff Cr;OVN ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with TheaSierADditor of the county
where the property is located during the twelve(12)months before March 31 of alch year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Shaun E. Cooper and Kara R. Cooper
Taxing District Key number/legal description Record number Page number
Ft. Branch 26-18-13-403-000.845.026 a-O 1 ka — 502 44
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?
126,700 180,000 0 Yes El 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
Fl Real Property ❑ Annually Accpccpd
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
USAA Federal Savings Bank
Address of mortgagee or contract seller(number and street.city,state,and Z/P 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 it)any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ,N(J, on property for
in Indiana? Yes No current year? ❑
El 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 I contract buyer of the aforementioned property on date applica' fil-�.
Sign ture(at"' full name) Date(month,day,year)
Full resident addr- applicant(number and street,city,state,and ZIP .de)
305 W alnut St, Fort Branch, IN 47648
Person authorized by duty 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 310,000.