HomeMy WebLinkAboutMortgage_Hagen (2) r*•> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°' a* FOR DEDUCTION FROM ASSESSED VALUATION
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s State Form 43709(R13/10-15)
;�' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
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 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)
ANDREW D. HAGEN
Taxing District Key number/legal description Rec4Ld number Pa r
Montgomery Township 26-17-29-100-004.716-021 /Rolling Meadow 12 2.083 AC o��)�,^ a urt
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apph nt the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
60,877.00 Y 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 Assnsed
F3eal Property Annually Assessed
,l_�r,/ Mobile Home(IC 6-1.1-7)
Name ofmortgagee or contras seller ��
Acceptance Home Mortgage, LLC VI
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
101 Plaza E. Blvd. Suite 232, Evansville, IN 47715 2p19
Name of assignee or other owner or holder of mortgage ?a 1 %
Address of assignee(number and street,city,state,and ZIP code)
N1v AUDITOR
Does applicant own property in ny If yes,what county? What Taxing District? Has this deductyqq,,q@gg tGitga If yes,state amount of deduction
other county on property for,n
in Indiana? ❑Yes No current year? LJJ 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 1 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.
Signature(owne full name) Date(month,day,year)
C , / / 2 y' /2019
F ident address of applicant(number and street,city,state,and ZIP code)
8737 S Meadow LN, Owensville, IN 47665
Person authorized by duly executed Power of Attomey or by IC 61.1-12-0.7 Date(month,day.year)
Address of authorized person(number and aTeet,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.