HomeMy WebLinkAboutMortgage_Helsley (7) .„0,50;)\. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a-_ FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R12/644) F IL '�,p County
2018
` .• Prescribed by Department of Local Government Finance Y
INSTRUCTIONS: 1 File Mark
To be filed in person or by mail. APR lj 2w' Form filed with:
Filing Dates: 1) Real Properly 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 ere i.2 > .perty is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. .��a -al ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with --irr.". -sq, r/ my
where the property is located during the twelve(12)months before March 6 .o Re n": cton is sought
See reverse side for additional instructions and qualifications. (if
Applicant(owner or contract buyer-see resbictions on reverse side)
Randal Scott Helsley
Taxing Disthct Key number/legal description Record number Page number
26-19-04-400-000.337-025/ Pt. NE SE 4-3-10 7.31 Ac. a6( } Act/C./
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?
yes 0 N
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
0 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Research Center LLC
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1400 Veterans United Drive Columbia, MO 65203
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 on property for -
in Indiana? ❑Yes ❑No anent year? ❑
n Yes O 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/co tract buyer of the aforementioned property on date application is filed.
Signag4(ow is II naq) Date(month,day,yea'
K -1 max/ 4m2017
Full resident address of applicant(number and s,-',city,state,and ZIP code)
5001 South 250 East, Princeton, IN 47670
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.