HomeMy WebLinkAboutMortgage_Brown (6) a/°-•nv STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
..e_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Forrn 43709(R72/s-14) -FILE 26 2018
Prescribed by Department of Local Government Finance ryp$. �J
INSTRUCTIONS:
F File Mark
To be filed in person or by mail. f111 2017 Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for whicMNlededuction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county wher- t - : .perry is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar yea .i ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must Me wit ip .r7a'ro or p(tlj county
where the property is located during the twelve(12)months before March 3 • x� arlhe- dt06n is sought.
See reverse side for additional instructions and qualifications. G1g50t`I
Applicant(owner or contract buyer-see restrictions on reverse side)
-
Caleb Brown
Taxing District Key number/legal description Record number Page number
26-11-15-202-001.397-027/ Sandy Ridge Est.Sec.A Pt. Lot 9-Gibson County ao n- 4(03`),
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 pf applit n legal or equitable owner?Il 61111 Yes ❑ No
If no,what is his I 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
Guaranteed Rate Inc
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
• 3940 N Ravenswood Ave Chicago, IL 60613
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
ocher county on property for _,
in Indiana? ❑Yes ❑No current year? 0 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)
/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 application is filed.
Sign ure(ownerss ) Date(month,day,year)
/Wt fifreadit 10/13/2017
Full resident address of applicant(number and street,city,state,and ZIP code)
2631 West 50 South, Princeton, IN 47670
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 510,000.