HomeMy WebLinkAboutMortgage_Moorehead ^•r.9. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
�i" State Form 43709(R13/10-15) T rte. 2017
.s ✓e Prescribed by Department of Local Government Finance gB„'r Fark)
mi.INSTRUCTIONS:
To be filled in person or by mail NOV-Fin ledAvith:
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 CO Auditor
property is located on or before January 5 of the immediately succeeding calendar year.
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the County Recorder
county where the properly is located during the twelve(12)months before March 31 of each year lM8SON COUNTY Attu,'um
deduction is sought. -
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Daniel A. Morehead and Stephanie M. Morehead
Taxing District Key number/legal description 262213200000763024/12055 S 50 W, Re rd number Page numbe r
Haubstadt, Indiana 47639 _Jb\� ��pq
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 egyiftrble owner?
$214,400.00 es ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
i
If name on record is different than that of applicant,indicate below: Is the operty in question: Annually Assessed
eat 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 property 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 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 pro erty on date plicatio 's filed.
S'� owner 11 name ///r/�/ , year) �1 C\ 7m'�` a CJ ' � 71 address of applicant(number and street,city,state,and ZIP code) rratiay
120 S 50 W,Haubstadt, IN 47639
Person authorized by duly 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 S 10,000.IQ-ET yy r\