HomeMy WebLinkAboutMortgage_Chapman � FOR DEDUCTION ROM ASS SSED VALUATION INDEBTEDNESS County Towns ear
>':� / State Form 43709(R12/6-14)
\•„_ Prescribed by Department of Local Government Finance - -
INSTRUCTIONS: f+�_ Mirk 20tfi
To be filed in person or by mail. �J 0 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 0•unii(••• or
located on or before January 5 of the immediately succeeding calendar year. '$A. r`ei:?ID!•.gGgrdes,
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the c�oo,gtKK9�N LINTY •UUI I UH
where the property is located during the twelve(12)months before March 31 of each year the deduction tShc&K3hf
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Chapman, Kyle T. & Breanna N. Merritt
Taxing District Key number/legal description Re u1^per Pa a nu r
Ft. Branch 26-19-18-303-000-607.026/EastView 5 �/ Q
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applian the sole
March 1,current year March 1,current year date of application legal or equi a owner?
98,500 112,917 112,917 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 t 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 state,and ZIP code)
P.O. Box 360, Jasper, IN 47547-0360
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own properly 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? ❑Yes No _ current year? ❑Yes ❑No
A person is not entitled to this deduction unless ter contract indebtedness that is recorded in the county
recorder's office(including any home equity lint -__‘:_rc.rn-r..__-_._ _.-�._,__ -._!e)that is the basis for the deduction.
Deduction approved in the amount of: 7� �6/ r ,r
Drawer NO ((-2 O �/
zo 20 •
30?-1_ zo 20
Signature of County Auditor Card 1\�,
O. Date(month,day,year)
I I We certify under the penalty of perjury the ect and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
'attire ' full namgJ\ fjce(month,day,year)
X 7-.22=16
II reside tad ress of app' r (nu ber a stre t,city state. nd ZIP code)
I svlle N X177) L
Person authorized by duly executed Power of ttomey or by IC 6-1.1-12-0.7 I 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 S 10,000.