HomeMy WebLinkAboutMortgage_Besing (5) e->o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:a ,_ i FOR DEDUCTION FROM ASSESSED VALUATION
\-� r State Form 43709(R13/10-15) Gibson Oakland City 2018
YPrescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Fo ie with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is soug71 T L T
Must be filed or postmarked with the County Auditor or County Recorder of the county where the r[ is 'FyLhll !Di Auditor
located on or before January 5 of the immediately succeeding calendar year. ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must tile with the County Auditor of the county :
where the property is located during the twelve(12)months before March 31 of each year the deduction ins lye C:�O
See reverse side for additional instructions and qualifications. MH' r J
Applicant(owner or tondaa buyer-see restncbons on reverse side)
_Kelly J. Besing lb
Taxing District Key number/legal description • Pa e number
Oakland City 26-14-18-304-000.698-007 GIBSON COtNSTY�LY DL"�ftis
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sale
assessment date.current year assessment date,current year date of application legal or equitable owner?
35,100 28,000 ❑ 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 dterent than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(1C 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)
PO Box 360 Jasper, IN 47547
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 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 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 Data(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 o h foremgg nn boned property on date application is filed.
Signature(owner's lull n // Date(moth,day ear)
,3-( 7
Full resident address of applican umber and street,ty state,and ZIP code)
215 Division St. akland City, 47660 -
Person authorized by duty executed Power of Atomey 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.