HomeMy WebLinkAboutMortgage_Seibert ,,,,SSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;4-- ` FOR DEDUCTION FROM ASSESSED VALUATION ��pp--
i State Form 43709(R13/10-15) Gibson 1' 1 -ice' vi 1 2019
S� 1' 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 > 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 yearthe
deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Mark A. Seibert , Abigail J. Hollis
Taxing District r Key-19- legal0 des000.00 Record'7.-0u1 ber P72__mber r
Pt sess `pe (� 26-19- Mortgage
I .007-026 2 CP p5 e11 le
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 I or equitable owner?
$88,500.00 111,510.00 Q(Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whdm
If name on record is different than that of applicant,indicate below: Is t property in question:Annually Assessed
O'Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
United Wholesale Mortgage ,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1414 E Maple Rd, Troy, MI 48083
Name of assignee or other owner or holder of mortgage -
AUG 19 2019
Address of assignee(number and street city,state,and ZIP code)
4.„---
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Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been rejlJBtl9K- s;state amount of deduction
other county on property for 41BSONMOU TY AUDITOR
in Indiana? ❑Yes ❑No current year? LJ Yes LLJJ 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 2 41\20 20 20 20 20
t
Signature of County Auditor I - Cy)
County Date(moat yay,V� t(jy IlQlI/We certify under the pena ty of perjury that th regoing information is true a d correct and that the applicant is resid kt of Indiana and-
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's yf ame) COTA Date(month,day.year)
3tiF7/fj 08/08/19
Full resident address of aappplicant(number and streetre
e,and I code)904 S Center St, Fort Branch, I48
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 S10,000.