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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ounty Township 1 Year 1
1:.,,I FOR DEDUCTION FROM ASSESSED VALUATION 1T-01\� I Z72022
l State Form 43709(R14/1-20)
File Mark
.I Prescribed by Department of Local Government Finance
INSTRUCTIONS: Form filed with:
To be filled in person mail.
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 County Recorder
and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Matthew W. Skeen II and Catelyn Crawford-Skeen
R cA number Page number
Taxing District CI �� Key number 26-11-12-204-002.028-028 7,1
, L I�
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is Is theo p j pqu f t thee sole
assessment date,current year assessment date,current year date of application g Yes 0 No
$95,959.00
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 e property in question: Annually Assessed
J Real Property 0 Annually Assessed
Name of mortgagee or contract seller f
Amerifirst Financial Corporation, ISAOA,ATIMA �_ Mobile Home (IC 6-1.1-7)
Address of mortgagee or contract seller(number and street,city,state,and ZIP cede)
950 Trade Centre Way, Suite 400, Kalamazoo, MI 49002 t 4? '
Name of assignee or other owner or holder of mortgage
c/ 6 2Oee
es1-)
ro e
Address of assignee(number and street,city,state,and ZIP code) COIN'��'
Does applicant own property in any If yes,what county? (What Taxing DistiAk:Was this dedu ion b n requested If deduction
amount of
other county OR on property for
in Indiana? 0 Yes ❑ 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 con a 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 he basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 I 20 I 20 I 20 I 20 I 20 I 20
County Date(month,day,year)
Signature of County Auditor ka! 1 14 N1��
I/ e certify under the penalty o per)ury that the abov nd foregoing information is true and correct and that the applicant is a resident of Indiana
and owner ntract buyer of the aforementioned property on date application is filed. IDat�(mo/�th,day,{ear)
Stur er's full n /�'/I /07? /.2Qa a
Full resident address of applicant e�treet,city,state,and ZIP code) // (/
915 Mill St., Princeton, IN 47670 Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
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.