HomeMy WebLinkAboutMortgage_Davis (40) �.s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �`. ' ' Townshi. Inerrala
FOR DEDUCTION FROM ASSESSED VALUATION �� ��. 2022
j 'a State Form 43709(R14/1-20)
.4•• -�/' Prescribed by Department of Local Government Finance File Mark
r ��
INSTRUCTIONS:
To be filled in person or by mail. Fo lied with:
Filing Dates: Form 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 calendar year in which the property taxes ae first due
and payable. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Tucker J. Davis
Taxing District Key number/legal description 26-11-12-104-001.840-028/ Record number Page number
Assessed vafl7L of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the plicant the sole
assessment date,current year assessment date,current year date of application legal equitable owner?
$142,929.00 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 t e property in question: Annually Assessed
Real Property ❑Annually Assessed
Fir:rye(IC 6-1.1-7)
Name of mortgagee or contract seller
AmeriFirst Financial Corporation, ISAOA,ATIMA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
950 Trade Centre Way, Suite 400, Kalamazoo, MI 49002 FEB 1 7 2022
Name of assignee or other owner or holder of mortgage ,4s�
Address of assignee(number and street,city,state,and ZIP code) Gfgg/7 Q Y / �UDITOR� E
Does applicant own property in any If yes,what county? What Taxing District? Has this C. •n .een requested If yes,state amount of
other county on property for deduction
in Indiana? 0 Yes `ii No current year? F, Yes No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or con ac 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 of County Audit r County Date(month,day yea
m, ' 4 -- ( b061,r) 0/7/(9
I/We certify under the penalty of perjury that the above and foregoing 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(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code)
1610 W Brumfield Ave., Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
x, C ---- 1
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.