HomeMy WebLinkAboutMortgage_Fonte d/TMno STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
„n _ _ �g FOR DEDUCTION FROM ASSESSED VALUATION
si State Form 43709(R71/6-14) ENTER°FOR T
ATION 2015
' -�i< Prescribed by Department of Local Government Finance DULY final tD eptaace lot transfer File Mark
eu
Subject to
INSTRUCTIONS: _�
To be filled in person or by mail. , _day o( ' 'I ' Fo , :d i 1
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the 'eduction is s pi0 �f
Must be filed or postrnarked with the County Auditor or County --corder -v unty wh S county �' ty Auditor
property is located on or before January 5 of the immediately I,.,);•`%t` �l-r year. • County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property file th the County Auditor of th AR , I
county where the property is located during the twelve(12)months ore March ar the
deduction is sought. Parcel*
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Whitney Erin Fonte and Ryan Parks Fonte GIBBON COUNTY AUDITOR
Taxing District Key number/legal description 26-18-15-100-003.992-021 /6614 S 325 W, Record number Page number
Fort Branch, Indiana 47648
26-18-15-100-003.992-021 40 i I /WW0
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1.current year date of application legal or equitable owner?
$252,000.00 ®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 the property in question: Annually Assessed
O 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, state, and ZIP code)
711 Main Street, P.O. Box 360, Jasper, IN 47577 .
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP cods
Does applicant own property in any If yes,what county? T `"`r'-' ' steel If yes,state amount of
other county Drawer 0)5 deduction
in Indiana? ❑ Yes O No ❑ No
,ff1� Card NO IOio
Deduction approved in the amount of: 95UCO
20 20 20 20_ 20_ 20_ 20_
Signature of County Auditor County Date(month,day,year)
I/We certify under 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 operty on date application is filed.
Si atu owner's tame) Date(mont ,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code)
6614 S 325 W, Fort Branch, IN 47648
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.