HomeMy WebLinkAboutMortgage_Brown (2) v"a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°e ;. ' FOR DEDUCTION FROM ASSESSED VALUATION
�� State Form 43709(R12/6-14) � 2019
•\ Prescribed by Department of Local Government Finance _PPP-
• File Mark
INSTRUCTIONS: MAY 7 •
To be filed in person or by mail. --' filed with:
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 propert is • Coun y Auditor
located on or before January 5 of the immediately succeeding calendar year. • ' ".l
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Audito oLf the•.•r i. U' "� County Recorder
where the property is located during the twelve(12)months before March 31 of each year the d�ehlota-Akbreti )N .. ; is
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jeremy R. Brown
Taring District Key number/legal description R nu Page u r
009 26-18-36-400-000.862-009/ E M B Estates Lot 2 -Gibson County XRj
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness Idasas of 9s the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
$216,000.00 p 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
F4 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Ruoff
Address of mortgagee or contract seller(number and sheet,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,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 ��yy on property for
in Indiana? ❑Yes LYfNo 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.
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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.
ignat (o,w
,—ners full name) Date(month,day.year)
id 2 cam_ �c(month, a� )s
Full resident ad ress of applicant(number and sheet,city,state,and ZIP code)
904 West Elm Street, Haubstadt, IN 47639
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.