HomeMy WebLinkAboutMortgage_Hull (3) ,....^�na STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°fQ FOR DEDUCTION FROM ASSESSED VALUATION
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S'• . State Form 43709(R13/10-15) Gibson Patoka 2018
� 5� Prescribed by Department of Local Government Finance
R File Mark
INSTRUCTIONS: �_j
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for whigpa�ttiik�ee •ggctilpm?y sought.
Must be filed or postmarked with the County Auditor or County Recorder di Fhb•... Aty 44hMFe the property 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 Properly:Must file with the Co u ty A 'er6f the county
where the property is located during the twelve(12)months before March 3l/,E4e f deduction is sought.
See reverse side for additional instructions and qualifications. .pro^n m r•nt r pl3v AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side) .
Sydney D. Hull
Taxing District Key number/legal description Re j Pao nuw1 r
Patoka 26-11-15-202-000.230-027 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
assessment date,current year assessment date,current year date of application legal or equitable owner?
79,800.00 137,365.00 EJ Yes ❑ 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
15I Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Ruoff Mortgage Company Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1700 Magnavox Way, Suite 220, Fort Wayne, IN 46825
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 y It yes,what county? Wnat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes No current year? ❑
DI 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)
1 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 application is filed.
Sign re( ers full name) �� �� Dale(rrlOnlh, ary
Full rest nt address of a licant(number and street,city,state,and ZIP code) I f�) l ' /
2535 W 50 S., 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$10,000.