HomeMy WebLinkAboutMortgage_Richeson M•^•., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
tl, ` State Form 43709(R13/10-15)
� '• Prescribed by Department of Local Government Finance
INSTRUCTIONS: 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 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)
imberly K. Richeson
T District • Key number/legal description pq� Pa� bey-•
id CO 26-13-20-101-000.4182-005 Rt dou IIp� i
value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebted ss unpaid as of Is the applicant the sole
assessment date,currentf app year assessment date,current year dye olication op legal or equitable owner?
V7 ITr ❑ 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 ❑ Annually Assessed
Mobile Home(IC 6-7.1-7)
Name of mortgagee or seller (
FBC Mortgage, LLC
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
189 S. Orange Avenue, Suite 970, Orlando, FL 32801 MAY 1
Name of assignee or other owner or holder of mortgage 0 2019
Address of assignee(number and street,city,state,and ZIP code)
_ GlaepN rr�nn 'J'�i.
Does applicant own properrrttryyy'n any If yes,what county? What Taxing District? Has this deduction beah're. .-Tel f Ilirw4t +Aamount of deduction
innd county on n yty rt
o Indiana?cou ❑Yes 0 currentpr year?rf ❑Yes ❑No
A person is not entitle to th 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 reside t of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
ignature(owners lull name Date L�/
AAA a
Full re t addresd of applicant(number and street,city,state.and ZIP code)
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,end ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.