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HomeMy WebLinkAboutMortgage_Utley 0"•$;t, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year k_ _ °\ FOR DEDUCTION FROM ASSESSED VALUATION IMI State Form erescribed by Dgpartrtmentlof L P Local Government Finance \- INSTRUCTIONS: IL . - File Mark To be filed in person or by mail with the County Auditor of the county where the property is ocated. Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. �q 0 901 2)Mobile/Manufactured Homes not assessed as Real Property:Must file during t/fv1n ivv(Y2)4rY n s 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 side) COUNTY AUDITOR David E.Utley GIBSON Taking District Key number/legal description Record number Page number Johnson 26-22-10-100-000.087-024 Pt NW 10-4-11 7.21 ACI D-2 ao 1 5/-1Q Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sae March 1,current year March 1.current year dale of application legal or equitable owner? 340,000.00 © Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom II name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed ©Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller German American Bancorp Address of mortgagee or contract seller(number and street.city.sale,and ZIP code) P.O.Box 360,Jasper, IN 47547 Name of assignee or other owner or holder of mortgage Address of assignee(number and street,city.state,and ZIP code) Does applicant own property in any other If yes.what county? What Taxing District? Has this deduction been requested on property county in Indiana? for current year? ❑ No ❑ Yes tallo ❑ Yes COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of County Auditor County Date(month,day,year) I I We certify under the penalty of perjury that the above and foregoing information is we 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(owners full name) pr /itybc (PErU.7}" I cl LUI4 L Full residen dress o applicant(number and street.city,state,and ZIP code) 11192 S Owensville Rd., Haubstadt,IN 47639 Person authorized by duty 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)