HomeMy WebLinkAboutMortgage_Blackburn (2) J.s-L-'"o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
z- 1 FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709(R13/10-15) Gibson Patoka 2019
S��__Y Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: Form filed with:
To be filed in person or by mail.
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. X County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the 0 County Recorder
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
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Melissa Blackburn
Taxing District Key number/legal description I Re9tg rd nurrter Page number
Patoka 26-11-16-400-000.147-027 -C Gl V L
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is th pplicant the sole
assessment date,current year assessment date,current year date of application I or equitable owner?
$84,900.00 108,007.00 Yes 0 No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,• state with whom
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Asarsced
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Stearns Lending, LLC
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
4 Hutton Centre Drive, 10th Floor, Santa Ana, CA 92707
Name of assignee or other owner or holder of mortgage AUG 1 3 2019
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in y If yes,what county? What Taxing District? Has this deduction beer ,te yAbbitf eirRunt of deduction
other county on property tot3ON C.�UN
in Indiana? El Yes LLLJJJ No current year? es L.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 0 20 20 20 20 I 20
Signature of County A/odd'o County Date1(rm—o1 h1d�d1y, e�r1,
I/We certify under the penalty of perjury t at the above and foregoing information is true and correct and that the applicant is�.resid>ntlofflIndiana and
owner/contract buyer of the aforementioned property on date application is filed. 11
Signature owner's roll name) Date(month,day,year)
(-4) P%Ipa r 08/09/19
Full resid nt address of app scant(number and street.city,state,and ZIP code)
1195 S Hoot Owl Lane, Princeton, IN, 47670
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.