HomeMy WebLinkAboutMortgage_Dent �pfkik STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•1 , co FOR DEDUCTION FROM ASSESSED VALUATION
i�x '$r '`" State Form 43709 R13/10-15 s'�
��' '`�' Prescribed by Depa ment of Local Government Finance
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INSTRUCTIONS: 401/ 1_ I—n,,,, r—. FEB 0 3 2021 File Mark
To be filed in person or by marl. " �"1 0 1 Form filed with:
Filing Dates: 1) Real Property:Must be mpleted 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 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)
Dent,Gregory M
Taxina District Key number/legal description Record number Page nu
Haubstadt 26-19-31-304-000.209-009/E PARK ADD 470/468/469 sCi 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?
112600.00 0.00 170.000.00 x Yes ❑ No
If no,what is his/her exact share of interest? If ow wit omeone other than spouse,indicate with whom
.4c1,1/4 . 1..
If name on record is different than that of applicant,indicate below: AS4: -\ / Is the property in question:Annually Assessed
rep cr'� x Real Property ❑ Annually Assessed
r Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sellerci%c1 z, CP'
Plaza Home Mortgage.Inc. C
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code) OP�,�
it,
542.0 SPauance Drive.Suite 200.San Diego.CA 92121 i, �J
Name of assignee or other owner or holder of mortgage r ,„0.11.
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Address of assignee(number and street,city,state,and ZIP code)
Does applicant own prope in any If yes•what county? What Taxing District? Has this deductio be requested If yes,state amount of deduction
other county on property for
❑Yes o in Indiana? current year? es ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c nt ct 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)the is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20_ 20 20 20 20
Signature of CountyA_uorr Gounly Date(month,day,year)
r� w �S 0�1 Z>`3,`lp Z)
I/We certify under the penalty of perjury that - -'eve and foregoing information i tru and correct and that the applicant is a resident of Indiana and
owner_Lcontract_buyer of_the_aforementioned_property on_date_application is.filed.------ ---• . ---
Si atu a(own full name Date(month,day.year)
Full resident addle o o can(number and street.city.state.and ZIP code)
210 S 4th Ave.Haubstadt.IN 47639
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 E 'NES
Name of applicant mort Name of agee or contra r el4.,
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Date filed ont ,d year Amount of inde to es Taxing DiVio®Z
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Key number/legal descriptiZ� �n 3 -boy —oo Z01_00q a. Aoa ° e , .,
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Signature of Col. Audit /Coun et ord County SO 1 e month.day,year) c r
C� G S �� Go so
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