HomeMy WebLinkAboutMortgage_Jorden STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
kir FOR DEDUCTION FROM ASSESSED VALUATION ���111
i• State Form 43709(R13/10-15) Gi n p 0Q) 2017
� Prescribed by Department of Local Government Finance :p1 L. -f $�
INSTRUCTIONS: 1File Mark
To be filed in person or by mail. MAY 1 : F'f! fled 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 ❑ Coun Auditor
located on or before January 5 of the immediately succeeding calendar year. I rrgiCounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must ble with the County Auditor of the 4. :flm�rh
where the property is located during the twelve(12)months before March 31 of each year the dedygUog- ,puyMU N • • s •
See reverse side for additional instructions and qualifications. lU II tt55
Applicant(owner or contract buyer-see restrictions on reverse side)
Mark W. Jorden; Jr. & Kathryn Jorden
Taxing District Key number/legal description Regr3u�
00 ber Page nu
Johnson 26-23-16-200-002.351-024 lL 046 I-
Assessed d value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,=rent year assessment date,current year date of application legal or equitable owner?
5,200 210,000 248,000 0 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 dtterent than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed 1I
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,dry,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 If yes,what county? What Taxing District? Has this deduction been requested It yes,state amount of deduction
other county ,__, property for
in Indiana? Yes 15I No current year? ❑Yes Li 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. .. . _
xSignaj,,uyye�(owner's full me) Date(month,day,year)
`ffie t l J/ 2� o�J1^t/t� • 05/08/17
Full resident address of applicant(number and street,city,store, nd ZIP code)
1589 E Warrenton Rd. 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) -
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10,000.