HomeMy WebLinkAboutMortgage_Layman o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4 _ .\ FOR DEDUCTION FROM ASSESSED VALUATION
3' i. State Form 43709(R13/10-15)
r.
•;r I Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by malt. Form Fled 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)
Christopher& Melissa Layman
Taxing District Key number/legal description Record number Page number
Fort Branch 26-19-18-200-001.372-026 2019 2121
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,anent year assessment date,cogent year date of application legal or equitable owner?
. 283,000 M Yes p 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 applican s the property in question:Annually Assessed
l`/��- ej(N�P�r�ppe Ann•uallly Assessed
C�1\r15 40Q _�/ Ho ne(IC G, ,_T)
Name of mortgagee or contract seller
Quicken Loans
Address of mortgagee or contract seller(number V/�y t� P.. AUG 2.2 2019
Name of assignee or other owner or holder of me L.....Cq1 1(/�/I`l�J `'nAddress of assignee(number and sheet,city,sta I II/Il u I ' I - 3`y**It-
0Does applicant own property in any If yes,wh: 0 \ een requested If yes,state amount of deduction
other county /� 1/�'�[
in Indiana? ❑Yes ill No ' I i C�i/ , 9\ Yes ❑No
A person is not entitled to this deduction un �/l` 1 tract indebtedness that is recorded in the county
recorder's office(including any home equit) 1 at is the basis for the deduction.
Deduction approved in the amount of: 'Al/�'�IrY^'�1'^`�" /��J�� On/'\
20 20 �-a 1 ` gig ,
�N 20 20
I I _ ,
Signature of County Auditor County Date(month,day,year)
•
1t-.r.*.Q-.1-�rA.. Gibson 08/22/19
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature(owner's fire name) Date(month,day,year)
/4-,._ 08/22/19
Full resident address of applicant(number and street,city,state.and ZIP code)
913 BlackFoot Dr., Fort Branch, IN 47648
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 310,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTED SSf
Name of applicant Name of mortgage or contract sell �➢`/,
Christopher& Melissa Layman Quicken Loans
Date Fled(month,day,yea() Amount of indebtedness Taxi is r0
8/22/19 283000 Fort Branc l ti R,
Key number/legal description F'
26-1
Signature of County odiitor/3County -Recorder County Da opfi,.�pQiU\TOR
JA..�.T._ / t- I Gibson r: 1,�.,t9N