Mortgage_Harris „k STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`rfn : FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
mid
” ''+j:, a State Form 43709(R13/10-15)
• `1e`1a-''=-1 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)
Heath R Harris
Taxing District Key number/legal description Record number ��tt Page number
Patoka R(0 -is - 15�'- 1 oo (y4 �-t rrl 3.'7—oc)i dbUdO-q 8
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?
15 l i D , d° ❑ 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:Annually Assessed
❑✓ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Broker Solutions, Inc., dba New American Funding and/or its Warehous-- - ;. -.r - „ -17 -,,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) e ii
14511 Myfo d Rand,Suite 100 Tustin,CA 92780 1 ' ILj-
Name of assignee or other owner or holder of mortgage
• ,IAN 0 0 2070
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been reques d ;f • tof:eduction
other county on property for I
in Indiana? CI Yes ❑No current year? ❑Y0lB i QOUNT`( ALL1 R
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recor.— 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
•
_ Sign County Auditor i County Date(month,day,year)
/ / 5� g/ - aO - 20Zt
I/ e certify under the enalty of perjury that th bove and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract bu of the aforementioned p perty on date application is filed.
nature(owner's full name) ate(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code)
945 S Deer Haven Dr, Princeton, IN 47670
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)