HomeMy WebLinkAboutMortgage_Meeks Trust �,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-a } FOR DEDUCTION FROM ASSESSED VALUATION 1 � �fi �� 7-0�
i State Fawn 43709(R12/6-14) 1\CO
Prescribed by Department of Local Government Finance -
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form 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. 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)
Della M. Meeks Trust
Taxing District Key number/legal description Record num r Page number
FT BRANCH TWNSHP 26-19-19-101-000.764-026 2 1 2-9Z5
Assessed value of real pi mty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid asof Is the applicant the sole
March 1,current year March 1,current year dale of application legal or equitable owner?
98,300.00 127,800.00 p 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
12) Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
MORTGAGE MASTERS OF INDIANA INC
Address of mortgagee or contract seller(number and street,aty state,and ZIP code) FILED
Name of assignee or other owner or holder of mortgage
.Address of assignee(number and street.a^ state,and ZIP code) AUG 2 8 Z019
Does applicant own property in any If yes,what county? What Taxing District? Has this dad pion Ee re If yes,state amount of deduction
other county on grope y r
in Indiana? OYes current No
A person is not entitled to is deduction unless the person has a balance on the person54 S6 pb GOV! xnfigiNg hat 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
Signature of County Audit XI_ (/ /+rt l Count - 1 ` �� Date(mVA` 171CA
`I/We certify under a penalty of perjury that tneabove and foregoing information s t aand correct and that the applicant(iss idresidt of Indiana and
owner/contract buyer.of the aforementioned property on date application is filed. — _
Signature(owner's full name) ' Date(month,day,year)
/ vo,_ 07/12/2019
Full resident address of applicant(number and street.city,state,and ZIP code)
503 E Oak St Fort Branch, IN 47648
Person authorized by dtiy executed Power of Attomey or by IC 6-1.1-12-0.7 I 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 510,000.