HomeMy WebLinkAboutMortgage_Bachman l �. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
c',...- ` �= FOR DEDUCTION FROM ASSESSED VALUATION4 es �> State Form 43709(R13/10-15) �o� y/Yn�/,'"'- �-� Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. orm 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)
Robert A. Bachman
Taxing District C^�- Key number/legal description Record number Page n er
26-18-24-202-000.128-026 9011
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 legal or equitable owner?
$80,808.00 .Yes 1=I 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 applicant,indicate below: Is th roperty in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Consumer Real Estate Finance Co. ISAOA/ATIMA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) r
115 NE 3rd Ave#706 Fort Lauderdale, FL 33301 - a '
Name of assignee or other owner or holder of mortgage
nEC042019
Address of assignee(number and street,city,state,and ZIP code)
L . ��'
Does applicant own property in any If yes,what county? What Taxing District? Has this dedu i If yes,state amount of deduction
other county on property fo
in Indiana? ❑Yes ❑No curr6[)t5S-ONQVIN NAJDjTOR
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 20 20 20 20 20 20
Signature of Caul; it } Z27 County l�o� Date(mo th,day, a
I/We certify under the penalty of perju a e above and foregoing information i�td�e and correct and that the applican is a residknt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signa ure owner's full name) Date(month,day,year)
/�J/` /� �- 107��11
( Full resident address of applicant(number and street.city.state,and ZIP code)
104 W Oak St, 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)
Thepenalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.