HomeMy WebLinkAboutMortgage_Gray (2) a -, a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;' la FOR DEDUCTION FROM ASSESSED VALUATION
pi a' State Form 43709(R 17/10-15)
-•""6y-` Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be tiled in person or by mail. Form filed with:
Filing Oates: 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. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 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)
Jason Gray and Stephanie Gray
Taxing District Key number/legal descnptian Record number Page number
Patoka 26-12-07-303-002.319-028 2-0tK 50.3Z
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?
$130,000.00 0 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
❑/ Real Property
FiMobi�jiprn (IC 1.1-7)
Name of mortgagee or contractseller tl jr
Quicken Loans, Inc. ISAOA 1s
Address of mortgagee or contract seller(number and street.city,state,and ZIP code) . 7 2018
1050 Woodward Ave., Detroit, MI 48226 DEC
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) 555 �CO N-("z AUDI1 OR
BSON
Does applicant own property in any It yes,what county? What Taxing District? Has this deduction been requested ItIff yes,state amount of deduction
other county on property for
in Indiana? ❑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
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 fled.
�3igraw (01 ers lull name) Date(month,day, ar)
/211Y id
Full r side t addres applicant(number and street.city state.and ZIP code)
51 S Hall Street, 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) lir
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. J�