HomeMy WebLinkAboutMortgage_Simmons (2) . . � . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°- 'Q FOR DEDUCTION FROM ASSESSED VALUATION
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al-'f'�`t//� State Form 43709(R13/10-15) -1tOf1 '02O
!y• `r%4'' Prescribed by Department of Local Government 'nance
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INSTRUCTIONS: � � � �.r�1 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in th alendar 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 X 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)
SIMMONS, LYNDSI RACHELLE and LUKE BENJAMIN
Taxing District Key number/legal description Record number Page number
FORT BRANCH 26-19-18-101-001.160-026/LITTLE YORK VILLAGE PH 2 LOT 21 2D20 135-1
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 a itable owner?
223,800 121,3000 243,016 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
United Wholesale Mortgage
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)"
585 South Blvd E, Pontiac, MI 48341
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in ny If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes No current year? ❑III Yes ❑No
A person is not entitled to 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 C unty Auditorr...���� County 1 Date(month,day,year)
�\ `� JyJ (r S0e) LI ^ ) - 2fl2/13
I/We certify under the pen y of perjury that the above nd foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contracLb.,uy , e aforementioned pip on date application is filed.
Signs`4`(o'wner's f me) D'atei(month,,.day,.year)
Full address of ' nt(number and street,city,state,and ZIP code)
401 S. State St, Chandler, IN 47610
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$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Nam IR ica;t /fJ
Neorcontntsertra.r.,
SlfYl`(`nQ(1S , 11.1nt,►_11 rW\ o1es,`','U.�- `i
Date filed(month,day,year) Amo t of ind btedness Taxin District
4-1.2,02,0 , 2�{30(6 Ffi 'I ncit)
Key number/legal description
26-- (6I ^1$-t01 - of - 160-026 ton- eN^1 -
Signature of County Auditor upr de County \ Da' 7 do'year)
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