HomeMy WebLinkAboutMortgage_Moog d//� sti STATEMENT OF MORTGAGE OR CONTRACT IND "tit unty Township Year
4a. FOR DEDUCTION FROM ASSESSED VALUATIOI
\: State Form 43709(R12/6-14) 26 001 2019
Prescribed by Department of Local Government Finance 2 6
INSTRUCTIONS: JUN 2 5 2010 File Mark
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 which t e deduct' n . ught.
Must be filed or postmarked with the County Auditor or County Recorder of II a pro e4y is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar yea 1 rt..? AUDIT U• ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Mus/jJIy1!9g a,jrybe.&annry Auditor of the county
where the property is located during the twewe(12)months before/IV/din-31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Christine E. Moog
Taxing District Key number/legal description Record molter Page number
001 26-20-11-201-000.182-001/Pt.W NE 11-3-9 1.10 Ac. -Gibson County I f- ay qp
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 of application legal or equitable Amer?
$79,670.00 E Yes ❑ No
It 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
rA Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Ruoff
Address of mortgagee or contact 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,cuty,state,and ZIP code)
Does applicant own propeggqyyy in any If yes,what county? VVnat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑yes No current year? ❑Yes El 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 I contract buyer of the aforementioned property on date application is filed.
tore(owner's fug name) Date( ont ,day,year)
�IW � 5Tli Ig
Fu resident address of applicant(number and sweet .4 state,and ZIP code)
5689 South State Road 57, Oa land City, IN 47660
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.