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HomeMy WebLinkAboutMortgage_Riley (10) .007", STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship�/ ,�t�, I Year ,; : 4, FOR DEDUCTION FROM ASSESSED VALUATION 3 - )' :'-"1 State Form 43709(R13/10-15) Gibson �,Olvt lvo l ki 2019 b '•-'e' Prescribed by Department of Local Government Finance �e�e 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) Jam_es &Lori Riley Taxing District Key number/legal description Record number Pa e number Columbia Township 26-13-13-300-001.318-006 2-01q l 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? $ 144,000 p Yes ❑_ 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 the property in question:A Assessed 0 Real Property.13 r5 L. assessed ' ob s e(IC 6-1 :1-7) Name of mortgagee or contract seller ',. Unify V . Address of mortgagee or contract seller(number and street,city,state,and ZIP code) q`� Name of assignee or other owner or holder of mortgage • �'OM"U©\ OR Address of assignee(number and street,city,state,and ZIP code) 'GOO" ' SONG Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requestl!a� If yes,state amount of deduction other county on property for in Indiana? ❑Yes El No current year? 0 Yes 0 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 /Sthat l isrecorded in the county recorder's office)that is the basis for the deduction. Deduction approved in the amount of: 01 v ( q 3 5 / 20 20 Drawer NO 20 20 Signature of County Auditor Date(month,day,year) 1-°""- - iha, Card NO. 12/5/19 I/We certify under the penalty of perjury that i . ect and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned I , Signature(owner's full name) Date(month,day,year) , 12/5/19 Full resident address of applicant(number and street,city,state,and ZIP code) 10969 E 100 S, Oakland City, IN 47660 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$10,000. r RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Name of applicant Name of mortgagee or contract seller James & Lori Riley Unify .04`c Date filed(month,day,year) Amount of indebtedness Taxing District CS' 12/5/19 $144,000 %Wm6jJs , 20/9 Key number/26-13-131300 00egal 1ption 1..318-006 S'0�C00 r>'4*-4,7, Signature of County Auditor/County Recorder County Date n'dn'ti1 y,year) > >t: ins-uk 1M Gibson 12/5/19 4/)