Loading...
HomeMy WebLinkAboutMortgage_Shaw ;i ^��o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION '' State Form 43709(R12/6-14) Gibson Johnson 2016 \ � Prescribed by Department of Local Government Finance INSTRUCTIONS: File Mark 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 property 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 County Auditor of the county where the properly 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 side) Charles E. Shaw II and Brenda K. Shaw Taxing District Key number/legal description Record number Page number • Johnson 26-23-07-200-001.115-024 c O t 13.2oR Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of IIT Is the applicant the sole a March I,current year March 1,current year date of application legal or equitable owner? 153,200 158,715 () Yes ❑ No II 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 Wells Fargo Bank, N.A. � ' ' ;la-lrlyo (IC 6-1.1-7) Name of mortgagee or contract seller j a/ 1 2701 Wells Fargo Way, Minneapolis, MN 55467 Address of mortgagee or contract seller(number and street,city,state,and ZIP code) APR 6 2015 Name of assignee or other owner or holder of mortgage n, r Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY AUDITOR Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been 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 contract 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 the basis for the deduction. 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/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner I contract buyer of the aforementioned property on date application is filed. ! S q ature owners lull /l,J� -A �//L�K� ./y, - I Date(month,day,yeah Oki"— !Q ii /d�,r,• fiV� /pl.J'/7 IX VKe 7ii�/ 4/2/2015 Fu resident address o applicant(number and street,city,state,and ZIP code) /"/ 439 E. Hirsch Woods Lane 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) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.