HomeMy WebLinkAboutMortgage_Parmer ^•4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
; 4 FOR DEDUCTION FROM ASSESSED VALUATION ��,��, '' Jr tor. • State Form 43709(R11/6.09) GigpyNT ai 2016
/ Prescribed by Department of Local Government Finance 11�rLL''11 i�i
INSTRUCTIONS: ile a
To be tiled in person or by mail. JAN FarIi�7 1�Of:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. l
Must be filed with the County Auditor or County Recorder of the county where the property is located a County Auditor
on or before January 5 of the immediately succeeding calendar year. n/ unty 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 y�` N COUNTY AUDITOR
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
MATTHEW R.PARMER and AMY M.PARMER
Taxing District Key number l legal description R number Page number
JOHNSON 26-22-01-102-001.055-024 dOlLt I 3r9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1.current year March 1,current year date of application legal or equitable owner?
233,00 202,000 161,125 0 Yes ❑ No
If no,what is Ns I her exact share of interest? If owned with someone other than spouse,indicate with whom ___
It name oh record is different than that of applicant,indicate below:' . Is the property in question:Annually Assessed;1r
O Real Property ❑Annually Assessed
' . Mobile Home(IC 6-1.1-7)-
Name of mortgagee or contract seller
• FIRST.NATIONAL BANK OF CARMI - - -
Address of mortgagee or contract seller(number and street,city.'state,and ZIP code) '
201 E. Main St.Carmi, IL 62821 •
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?
❑ Yes 0 No ❑ Yes TA No
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 true and correct and that the applicant is a resident of Indiana and elhAntA-owner/con t buyer of the aforementioned property on date a p cation is filed.
§giattuyllh(olw1 a e X11 name) ryy� l/nU/Ii Date(month,day,year)
Fug resident ad ress of applicant(number and street,city, rid ZIP code)
1101 W.STATE RD 68 HAUBSTADT,IN 47639 -
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)