HomeMy WebLinkAboutMortgage_Lewis (6) ei_^a.o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
` ' State Form 43709(R12 I 6-14) f N f
\fit Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be tiled in person or by mail. D E 8064 ay
Filing Dates: 1) Real Property: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 where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deductioral&gram C O U N t Y AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
GREGORY M. LEWIS AND JACKIE T. LEWIS
T g District Key number/legal description Recor num Page number
Frimgan aco-ia -1 t' 3a/-oa .ras - oaa /�}- y
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,a t r March 1,current year date of application legal or equi a owner?
H b00 68,000 es ❑ No
If no.what is his/her exact share of interest? I If owned with someone other than spouse.indicate with whom
If name on record is different than that of applicant.indicate below: Is theffireperty in question:Annually Assessed
IEP-eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
HERITAGE FEDERAL CU
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
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 ,-1,/ on property for
in Indiana? ❑Yes o 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.
Signat ' owner's full name Date(month,day,year)
aim . . . _ ;9 i� 12/12/2017
Full esid c/a•.$j ss of applicant(number and street,city,state,and ZIP code)
200 S AIN ST 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$10,000.
., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION {Iprye
1-' Slate Form 43709(8Prescribed 0.75) �� p Prescribed by by Department of Local Government Finance 1J
Mar
INSTRUCTIONS: DE R
lb be filed in person or by mail.
-
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the property is ❑ i w or
located on or before January 5 of the immediately succeeding calendar year. ; *.
2) Mobde/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the ntd1 �� Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction ht- C. T AUDITOR
See rave for additional instructions and qualifications.
( o r c o n t r a c t b u y e r-see restrictions on ....rave.--�O `Tn Cid a i u V Cs
-r l' Key i 'ill 3o ooi g4s- oat °71` Page
•
Assessed value of real property as of Mort gage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,anent year date of application / /'1 legal or equitatle owner?!9 ❑ Yes ❑ No
tf 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 property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mob&Home(IC 6-1.1-7)
Name of mortgagee or contract seller yriA
Address of mortgagee or contract seller(number and ,state,and ZIP code)
•Name of assignee or other• ,y o , age. /J Oa ��G dY
d ZIP n(de)
Address of assignee(number an dry,state,arhd ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Ilas this deduction been requested If yes,state amount of deduction
other county ❑ pntn ❑'aIMiana? Yes ❑No 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
recorders office(including any home equity line of credit that is recorded in the county recorders 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 buyer of the aforementioned property on date application is fled_
Sig�g�/+re(moires huI Date(month.day,year)
Nnei al �-�(i(number
'Fug of applicant(number and sheet,a*state,and ZIP code)
ZOO s.Ma i n rs-I- PNhce.Jvvt ...DJ if-707O
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 shy,state,and ZIP code)
' The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed$10,000.