HomeMy WebLinkAboutMortgage_Perkins (2) /a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
_ 't FOR DEDUCTION FROM ASSESSED VALUATION County Township1 Year
State Form 43709(R13/10-15) 1 o I n n I 20\9
4,c- Prescribed by Department of Local Government Finance On �1'"Ie LAI
INSTRUCTIONS: File Mark
To be filed in person or by mail. r 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. GGGFFF--- 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 resbictions on reverse side)
KEITH EDWARD PERKINS
axrn strict Key number./legal e a scription Record number Pa number
Xi,- H-I -t-ko3 -o01 .283 -00v- 2_o)R . Ikb .
Assessed value of real pro s of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,currem year assessment date,current year date of application legal or equitable owner?
54,439 o 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
0 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
MORTGAGE MASTERS OF INDIANA INC Frrri np
Address of mortgagee or contract Seg dry,er(number and street, state,and ZIP code) . J
l__ s
Name of assignee or other owner or holder of mortgage
AUG 13 2019
Address of assignee(number and street citty state,and ZIP code)
Does applicant own property in any If yes.what county? What Taxing District? Has this deduction DdC/cequested• If yes,state amount of deduction
other county on prope®I'SS9 CO, : ,_IV"(;
in Indiana? ❑Yes In No current year? lJ Yes 1"
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 2 20 20 20 20 20
Signature of County.Auditor sar‘r rRIf( County Date(mg, da .y
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is aresid t of Indiana and
owner/contract buyerp of the aforementioned property on date application is filed.
igna (o is full ante)#� ^p , Date(month,day,year)
y yy/ (Lfr.j. /f/// 07/25/2019
Full resident adcress at applicant(number and street cry.sta.and ZIP code)
231 E COLUMBIA ST OAKLAND CITY IN 47660
Person authorized by duly executed Power of AComey or by IC 5-1.1-12-0 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 S 10.000.