HomeMy WebLinkAboutMortgage_Loomis .o.;. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,p ` FOR DEDUCTION FROM ASSESSED VALUATION \ //-^� 202 I
State Form 43709(R14/1-20) `S�� V
� Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS:
To be filled in person or by mail. Form filed with:
Filing Dates: Form must be completed and dated in the calendar year for which the deduction is sought. El
be filed 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 ae first due County Auditor
and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Casey Loomis
Taxing District �7 Key number/legal description 26-17-12-201-000.226-022/108 S. Church Record number Page number
a G.---- St.,Owensville, Indiana 47665 RCSa‘ Le F 23
"1ssessed 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?
$249,000.00 ❑O Yes 0 No
If ono;Il fiatis his4 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
O Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Research Center, LLC dba Veterans United Home Loans, ISAOA/ATI -q i L ED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1400 Veterans United Dr,Columbia, IN 65203
Name of assignee or other owner or holder of mortgage
DEC 2 2 2021
Address of assignee(number and street,city,state,and ZIP code) ,,/
Does applicant own property in any If yes,what county? What Taxing District? J,,ItIvisrtgfle ested If yes,state amount of
other county •J r!leilirityOtnfklr A DITOR deduction
in Indiana? 0 Yes 0 No current year? Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co t 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 i the basis for the deduction.
COUNTY AUDITOR
'Deduction approved in the amount of:
20 20 20 Ie 20 20 20 20
Signature of County Auditor .. County \ O {\ Date(month,day,year) 2 ��L(
LcJY,.,.t► 'S (...)._3
.5 \ \`1,- 2 ,
1/We certify under the penalty of perjury that the above and fore oing 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 is filed.
Signature(owner's full name) Date(m nth,d y,year)
Full resident address of nt(number and street,city,state,and ZIP code)
108 S Church St., wensville, IN 47665
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 periury can include imprisonment un to two and a half years and a fine not to exceed$10,000.