HomeMy WebLinkAboutMortgage_Morrison . 9 v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a " FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RI3/10-15) 2017
Prescribed by Department of Local Government Finance File Mark
a• ��"-i"�
INSTRUCTIONS: R t,L Ej
To be filled 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 thodaRnti,oemehb ❑
property is located on or before January 5 of the immediately succeeding calendar year. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Audit of th ❑ County Recorder
county where the property is located during the twelve(12)months before Ma 31 of r e
deduction is sought.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Jared R. Morrison and Allison D. Morrison
Taxing District Key number/legal description 26-22-14-300-000.121-024/2444 W 1300 Record number Page number
S, Haubstadt, Indiana 47639 as I} I ISM
Assessed value of real properly as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant d e sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
5276,000.00 El 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
El 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 code)
Does applicant own properly in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes O 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 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.
Signature(owner's full name) Date(month,day,year)
0fr;eren a on„� � - y /3-I 7
ull resident address of applicant(number and street, state, and ZIP code)
2444 W 1300 S, Haubstadt, IN 47639
Person authorized by duty executed Power of Attomey 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. _--