HomeMy WebLinkAboutMortgage_Haake (2) s*-•.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION LEIL)O a rp�b z2
~ ✓✓ Prescribed by Department of Local Government Finance 1ii
File Mark
INSTRUCTIONS: MAR 2 4 2022
To be filed in person or by mail. Form filed with:
Filing 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 propert is 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 c oQfl r, 4,
where the property is located during the twelve(12)months before March 31 of ea I LFibtYiP`i1AJFrfJR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Haake, Debra A.
Taxing District Key number/legal description Re rd nu fbpr Page number
Fort Branch 26-18-13-404-000.111-026 a- ..D
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?
$89,540.00 El 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 Mobile Annually
Home(IC 6-1.1-7)
Name of mortgagee or contract seller '
AmeriFirst Financial Corporation
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
950 Trade Centre Way Suite 400 Kalamazoo , MI 49002
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own prope in y If yes,what county? What Taxing District? Has this deducti n en requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? Yes D No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or act 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 off/c th is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 C20
Signature of County Auditor County Date tgi2th,,d ,-77: / 2_
I/We certify under the penalty of perjury that the ove d foregoing information is and correct and that the applica is a r ident of Indiana and
owner/contract buyer of the aforementioned property n date application is filed.
Sign ure(own is f Ina /- Date(month,day,year)
C_� �"r�J 03/18/2022
Full d n ress of applicant(number and street,city state,and ZIP code)
102 East Strain Street Fort Branch Indiana 47648
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yeah
Address of authorized person (number and street,city,state,and ZIP code) ,., "4, ..ti
Z
i%7.
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. _e