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HomeMy WebLinkAboutMortgage_Gentry (6) e n%f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709 par/6-14) �Gtbepn Johnson 2017 �,,,, Prescribed by Department of Local Government Finance Jppl.r°� 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���yyyctinis?lktht. Must be filed or postmarked with the County Auditor or County Recorder of the'iYiinty 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 Properly:Must file with the unty a county where the property is located during the twelve(12)months before March 31 of 'lion is sought. See reverse side for additional instructions and qualifications. niRsON COUNTY AUDITOR '' Applicant(owner or contract buyer-see restrictions on reverse side) Dana M. Gentry and Jason B. Gentry Taxing District Key number/legal description Record number Page number Johnson 26-23-13-100-001.940-024 aolC a9SS 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? 269,700 340,000 p 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 German American Bancorp FA Real Property ❑ AnnuallyAssessed p Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller 711 Main St. Jasper, IN 47546 — Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 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 y 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? 0 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. I 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/contract buyer of the aforementioned property on date application is filed. f ggnature(owner's full r r Date(month,ya!1az I FYI /( ICY I Full resident address of applicant(n mbar and street,city,state,an IP code) I 5033 E 1200 S 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) *r.a flan-aria*f r aril nr can include imprisonment uo to two and a half years and a fine not to exceed$10,000.