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HomeMy WebLinkAboutMortgage_Domes (2) 90 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION '',•7 1 State Form 43700(R14 i 1-20) ' -? Prescribed by Department of Local Govemment Finance File Mark INSTRUCTIONS: To be flied in person or by mail Form filed with. Filing Date: Form must'be completed and dated in the calendar year for which the deduction is sought. 0 Courtly Auditor Must be f led or postmarked with the County Auditor or County Recorder of the county where the property is located on or before January 5 of the calendar year in which the property taxes we first due and payable. 0 County Recorder See reverse side for additional instructions and qualifications, 'Applicant(owner or contract buyer-see restrictions on reverse skis) Steven L. & Cecilia A. Domes Taxing District Key number/legal description Record number Pa a number Patoka Township 26-_12__-15-200-000.282-027 a O 0 Assessed value of real property as of 1 Mortgage r Contract indebtednessunpaid as of Mortgage/Contract indebtedness unpaid as'of 1 to the applicant thehe sole assessment date,current year I assessment date,current year l dats ct application legei or equitable owner? 41- /(4,3aLI ®Yes ❑No if no,what is his/her exact share of interest? If owned with someone other then spouse;indicate with whom . N/A N/A (If name on record is different than that of applicant indicate below, is the property in question:Annually Assessed 1 A l Real Property 0 Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller 'r American Financial Resources i .x{ Address of mortgagee or contract seller(number and street d7y,state,and ZIP code) 4 P.O. Box 37628, Philadelphia, PA 19101-0626 Or�O Name of assignee or other owner or holder of mortgage10.. -- N/A P' 3• Address of assignee(number and street city,state,and ZIP code) ,cO'� N/A p,�o� Does applicant own pro perty party in any U yes,whet county? What Taxing District? Has this deduction been request1 , tote amount of deduction other countyon propertyin Indiana? ❑Yes �l No current n ge Yes ` A person is not entitled to this deduction unless the erson has a balance on the person's p 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 ©eduction approved in the amount of: 2 / • 20 20 } 0 20 }i 20 j 20 20 j Sign tore of County Auditor Couunty Date(month,day.year) - nr,. Lb �. �l -�- ono I l We certify under the penalty of perjury that the ova an regoing information is true and correct and that the applicant Is a resident of Indiana and owner!contract buyer of the aforementioned property on date application i. filed. Slgnalwelown irena u) Date(month,day,year) ard..:".. -3 -aoa0 Fuf,resident address of applicant(number and stree e city,state,and ZIP ) 3097 E Curtice Lane, Princeton, IN 47670 i 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 (mrmberand 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 310,000. F . ,___. __ RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Name of app.icarl Name of mortgagee or contract seller i•: Steven L. & Cecilia A. Domes American Financial Resourc�'R 3 2�20 "Date fled(month,day year), Amount of Indebtedness Taxing District g 3 - c)-° 4 //1, 3 f34f Patoka T $: shi; 26-12-15 legal200-000.282-027 fesON COUNT , t S gnu {County Auditor 1 County er County �/CI-gm-20 O