HomeMy WebLinkAboutMortgage_Bright /,.s- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
i-4 % FOR DEDUCTION FROM ASSESSED VALUATION S-)�I Iq
-It". State Form 43709(R13/10-15) M n !-y
- -' Prescribed by Department of Local Government Finance , '\v 1-r or IA 3.10
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form Med 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 res(ric:ions on reverse side)
Brittany R. Bright
Taxing District Key number/legal description Recordrymber Page number
Columbia Township 26-14-18-302-001.384-007
Onr/ � / L2
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?
$58,913.00 ❑ Yes ❑ No
It no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑� Real Property ❑ Annually Assessed
Mobile Home pC 6-1.1-7)
Name or contract seller FILED
Ruoff MortgagegeCompany, Inc. ISAOA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1700 Magnavox Way, Ste. 220 Fort Wayne, IN 46804
Name of assignee or other owner or holder of mortgage MAY 6 2019
Address of assignee(number and street,city,state,and ZIP code) Flagg/
•
Does applicant own property in any It yes,what county? What Taxing District? HaSt1 - /'Qjr 4s It yes,state amount of deduction
other county on property forfli OITOR
in Indiana? ❑Ye ❑No current year? ❑Yes u No
A person is not enti ed this deduction unl s the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(in udi g ny home equi line )(credit that is recojAIToR
ounty recorder's office)that is the basis for the deduction.
v in amq('
ril
20 20 20 20 20 20 20
Signature of County Auditor 1 County a, Date( • d y• ar)q
V \ 301\ ?/We certify under the penalty of perjury that the above and foregoing information is and correct and that the applicant is rest nt o Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si nature owneh lull me Daze(month,day,year)
if cant SIZIZU Iq
Full resident addre of applicant(n er and street.city,state.and ZIP code)
►fig S- Mtiin sl. oAKIAnd ['Ay, IN Cajpi yi660
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 hall years and a fine not to exceed 510.000. ,