HomeMy WebLinkAboutMortgage_Cincirpini STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
dreE FOR DEDUCTION FROM ASSESSED VALUATION
\=�SState Form 43709(R13110-15) Gibson Ft Branch 2018
- Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: Form filed with:
To be tiled in person or by mail.
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sough T 10—Ct1 uditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the , n ,to ecorder
property is located on or before January 5 of the immediately succeeding calendar year.
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 DEC 2 8 2018
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) ae •„
Justin T. Cincirpini , Jessica N. Cincirpini GIBSPI "r"1"r-" '1_nrlT o
Taxing District Key number/legal description R nurribei Page number
Ft Branch 26-19-19-101-000.609-026 Ail--Site
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 egaI or equitable owner?
74 900.00 84,900.00 of 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 a property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Hometown Lenders LLC
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
310 The Bridge Street 4th Floor Suite A, Huntsville, AL 35806
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 ai}y' If yes,what county? What 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 ❑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 forego information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on dat japplicati 5js'fileed.
Signature er's full name) / Date(month,day.year)
12/12/18
Fu dent addre of ap tit umber a street,city,state,erg ZIP
604 S Lin In,- nch, IN, 47648r
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.