HomeMy WebLinkAboutMortgage_Doan STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
a FOR DEDUCTION FROM ASSESSED VALUATION
L State Font 43709(R12/6-14) 2018
-;; Prescribed by Department of Local Government Finance
Ii 2 Mark
INSTRUCTIONS: -.._
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought 11 S'2110
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the pro isl ' 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 County Auditor of the •unty
where the is located during the twelve(12)months before March 31 of each • -
ProPnstru n9 ( ) year the deducfi./ i. �mt/i:
See reverse side for additional instructions and qualifications. cIo N•COUNTY AUnITOR
Applicant(owner or contact buyer-see restrictions on reverse side)
Darrell W Doan and Mimi I Sung
• Taxing District Key number/legal description Ri nun r P 048,
26-04-25-104-000.069-020/ Pt. NW 25-1-11 .7445 Ac. I.j
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,anent year March 1,current year date of application legal or equitable owner?
(0/ 0 Yes ❑ No
If no,what is his/her exact share of interest? If owned with somedne other n 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
Ruoff Home Mortgage
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
. 1700 Magnavox Way Ste. 220 Fort Wayne, IN 46804
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street ary,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 3000.00
in Indiana? ❑Yes ❑No current year? O 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 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 buye • : -forementioned property on date application is filed.
ignature( full na -) Date(month,day,year)
8/4/2017
FJII address of appli umbe and street,city state,and ZIP code)
503 South Old Patoka -oad, Patoka, IN 47666
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$10,000.