HomeMy WebLinkAboutHomestead_Harnishfeger STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
e FOR DEDUCTION FROM ASSESSED VALUATION
,',tfigeJ,F State Form 43709(R13/10-15)
`°--;. Prescribed by Department of Local Government Finance
INSTRUCTIONS: FII
_ ii,„..,
To be filed in person or by mail. or lit_
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sough J' fi
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year r,� {� • q�itouniy Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cgyv 2 Lug
where the property is located during the tvreNe(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) ,���� r
Robert Gene Harnishfeger JR. and Robin E Harnishfeger GIB ON COUNTY AUDITOR
Taxing District Key number/legal description Record number Page number
Johnson 26-23-06-200-000.787-009 /(7-01'2y'-/
Assessed 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.current year assessment date.current year date of application legal or equitable owner?
$113,050.00 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
GI 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)
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 properly in any If yes.what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county „ property for
in Indiana? Yes 0 No current year? ❑Yes 12 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/ ontract buyer of the aforementio property on date application is filed.
Signatur Iles see na a1 Date(month. ay.year
X .,/tom• . n� 3/
Full resident address o.applicant(. rob r . . _et city stare.and ZIP code) /
517 South Eighth Avenue, 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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10.000 -
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