HomeMy WebLinkAboutMortgage_Wolf /-1 a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°/ e FOR DEDUCTION FROM ASSESSED VALUATION gp �•
'•, State Form 33709(R13 I 10-15).1.13:11 p..� Ipgt
,�? Prescribed by Department of Local Government Finance AA _r� T /E
INSTRUCTIONS: File Mark
To be filed in person or by mail APR 2 3 2019 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. IJ
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 Audit
where the property is located during the twelve(12)months before March 31 of each yemtps tie
See reverse side for additional instructions and qualifications. UDITOR
A (yha fle.:.
e s 7uyer-aeres c_. on reverse e) %k ^ - ithi�
Taxing District Key number/legal`description /J\/ Record number Page number
Columbia 26-14-18-104-000.155-007 010 / 1 /G+ 0 (,
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?
107,007.00 ❑ Yes ❑ No
If no,what is his I 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 ❑ Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc. ISAOA
Address of mortgagee or contract seller(number and street,city.state.and ZIP code)
501 NLon cme E..4 i.na W MI5
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? I 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 f County Auditor /o''�I`� County Date(month.day,year)
I/WeI/ certify p natty of natty of perjury above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contrac buyer of the afore entioned property on date application is filed.
` /cignatur (owner's uiname- Da.e(mopth. ear)
Full resident address of applican' number and street.city state.and ZIP code)
622 N Main St, Oakland City. IN 47660
Person authorized by duly executed Power of Attorney or by IC 6-1.t-t2-0.7 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 halt years and a fine not to exceed$10,000.