HomeMy WebLinkAboutMortgage_Simmons (4) 't STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION (�\�� 0 '')‘ 2020
,,if , - State Form 43709(R13/10-15)
N.'1'13"r" Prescribed by Department of Local Government Finance File Mark
leo
INSTRUCTIONS:
To be filled in person or by mail. Form fil with:
Flung 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 County Auditor
property is located on or before January 5 of the immediately succeeding calendar year.
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the 0 County Recorder
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)
Jordan Simmons
Taxing District Key number/legal description 26-12-06-401-001.027-028/1509 Record number Page number
Cottonwood Dr. Princeton, Indiana 47670 . 2O v 34,2 2
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?
$150,895.00 ❑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
0 Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �S
New American Funding °y
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ,, ' .
14511 Myford Rd., Ste 100,Tustin, CA 92780 4,,
Name of assignee or other owner or holder of mortgage
2Q;Q
Address of assignee(number and street,city,state,and ZIP code) O'/es
O/VL, �i i
Does applicant own property in any If yes,what county? What Taxing District? Has this ded!u bp.• requSted If yes,state amount of
other county on property for lUD deduction
in Indiana? ❑ Yes D No current year? 0 Yes /TOp 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 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
Si nature of County Au or County Date(mo th,day,year)
Er . .( )acoDo
I/We certify under penalty of perlui*thaUie above anZ9'foregoing information is true and correct and that the appli nt is a resident of Indiana and
own r/contract buyer of the aforementioned property on date application is filed.
3,inaB re(owner' u ame) `Dad(month, day,year)
X c fie/2ca
Full esident addres efaPP li pant(number and street,city,state,and ZIP code)
1509 Cottonwood 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.