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din,,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi. I Year
<e_'�_° °.• FOR DEDUCTION FROM ASSESSED VALUATION
:z State Form 43709(R13/10-15) �-
„_ Prescribed by Department of Local Government Finance p
t /
INSTRUCTIONS: de Mark
'
To be flied in person or by mail. 1' Form feed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deducll 4Ys ught.
Must be filed or postmarked with the County Auditor or County Recorder of the county where Therdig#is ❑ County 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 Auditor I the county
where the property is located during the twelve(12)months before March 3I3p bl�+s.cougM.
See side for additional
or contract buyer-see erresmcti nsdn reverse qualifications.
ide) COUNT,,
KEITH A. HUNT & PATRICIA A. HUNT
Taxing District Key number/legal description RecordI uIr Pager umber
WASHINGTON TWP. 26-05-01-400-000.635-017 /o 9S2
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?
$147,250.00 ❑ Yes ❑ No
If no,what is his I her exact share of interest? It 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 Aswssed
GI Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
•
CALIBER HOME LOANS, INC. ;On — 1Aci p
Address of mortgagee or contract seller(number and sir t rj��r ``\ (�
1199 SOUTH BELTLINE ROAC �Ge" � - P\ d V l 9
Name of assignee or other owner or holder of mortgage Q \ �'- c"— C1Cp,>,2
Address of assignee(number and sheet,city,state,and: \ (1c it- \4---t )....So
t
Does applicant own p perty in any If yes,what countyr mat lacing District? Has this deduction been request If yes.sate amount of deduction
other county n on property for
in Indiana? �s ❑No 1"x2 f P I O r i 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/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/contract buyer of the aforementioned property on date application is filed.
SignatupSownera hill name) Date(month.day,year)
x fa,&'tth. 4 .A/sena,- 1.e�� ,2 yLcr..t- 05/ 5 /2017
Full resident address of applicant(number and street.city,state,and ZIP code)
6627 N. STATE RAOD 65, HAZELTON, INDIANA 47640
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.ply,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.