HomeMy WebLinkAboutMortgage_Miller (41) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cqunty Township Year
7 �`.V FOR DEDUCTION FROM ASSESSED VALUATION l n^ ..
iX' "ei:"? State Form 43709(R13/10-15) RECEIVED 3 ,.,„. O2' (�22Prescribed by Department of Local Government Finance
INSTRUCTIONS: 1 pria_. a APR 0 8 2022 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Mu a 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 property is 4 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 sidel
Miller,Arin Leann
Taxing District _ .1 Key number/legal descri n26n Record Paq�ry�pitiler)
26-1 8/SS ADD 347 (�ffJi `r(�l�Al'�
Assessed value of real property as of Mortgage/ tract indebtedness unpaid as f Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessmentasse
date.current year ss da curte eay, ,./' date of application legal or equitable owner?
22 .Y1 t x Yes 0 No
If no,what is his/her exact share of interest? ` If owned with someone o than use,indicate with whom
If name on record is different than that of applicant.indicate below: Assessed
I1,J'_J_,
T x Real Property IDAnnual Assessed
■/ Mobile Home(IC 6-1.1-7)
r
Name of mortoanee or contract seller A
Equity Prime Mortgage,LLC APR 1 2 2022
Address of mortoaaee or contract seller(number and street.city state.and ZIP c el
PO Box 1194.Springfield.OH 45501-1194 �l t9ISS �1�
J�
t� ./
Name of assignee or other owner or holder of mortgage ON COUNTY AUDITOR
•
Address of assignee(number and street,city,state.and ZIP code)
Does applicant own property in If yes,what county? What Taxing District? Has this deductio n requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or Fact 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 offic )th is the basis for the deduction.
COUNTY AUDITOR
• Deduction approved in the amount of:
20 20 20 20 ( 20 20 20
Signature of Cou A or q
County { Date(mo th. e )
I/We certify under the penalty of perjury that the above and foregoing information tr a and correct and that the applicant is a r siden of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Sig ure(own s full name) Date(month.day,year)
Fur' residen ress of applicant(number and street city state.and ZIP mdel
914 S Stormont St,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)