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Home My WebLink AboutMortgage_Poling x" ).A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court wnshi Year FOR DEDUCTION FROM ASSESSED VALUATION �� Jr' S•"et State Form 43709(RU/6-09) GIBS I ,(iICAJ 2017 ,a„ I Prescribed by Department of Local Government Finance JJII INSTRUCTIONS: DF ile Mark To be filed in person or by mail. Form 'led T. Filing Dates: 1) Real Property:Mist be completed and dated in the calendar year for which the deduction is sought. Must be filed with the County Auditor or County Recorder of the county where the property is located C• n Auditor on or before January 5 of the immediately succeeding calendar year. j'1. •L efi.My Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County AuditorcMSON i O }-r• _ county where the property is located during the twelve(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) BRITTANY L. POLING Taxing District Key number/legal description Record number Page number PATOKA 26-11-13-202-002.086-027 /0 Cl — S (Ll c Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole March 1,current year March 1,current year date of application legal or equitable owner? 143100.00 146176.50 105000.00 ❑ 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 ❑Real Property ❑Annually Assessed 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,city,state,and ZIP code) 201 E.MAIN STREET,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 other If yes,what county? What Taxing District? Has this deduction been requested on property county in Indiana? for current year? ❑ NO ❑ yes ❑ yes ❑ No 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 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 of the aforementioned property on date application is filed. 1 Date(month,d yet) /) of A 1249(1`7 Fu resident address of ail t number a .street,city,state.and ZIP code) Person authorized by duty 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) s. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year Go, FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R13f 70.75) Prescribed by Department of Local Government Finance FII,ED INSTRUCTIONS: - To be filed in person or by mail. Force filed with: Filing Dates: 1) Real Property.Most be completed and dated in the calendar year for which the deduction is sought ��Q Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is MAR 2 01 agilly Auditor located on or before January 5 of the immediately succeeding calendar year. 2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county//�j�� ❑ County Recorder where the property is located during the heel a(12)months before March 31 of each year the deduction is so reverse side for additional instructions and qualifications. Applicant(owner or contract buyer---�: on reverse side) I G(BSON COI.Ib1TV AIIf11Tf]R arks) e - Taring District - number! •4'•. Recall number Page number � - r: -aoa- )t a. on -oat I � 51 � Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of .Is the applicant We sole assessment date,amend year assessment date,arrant year data of a • legal or equitable owner? 5 (532) oyes ❑ No ex If no,what is his/her exact share of interest? If owned with someone aherlhan spouse,indicate with whom If name on record is different than Tl - Is the property in question:Annually Assessed . POtiJ 6/ /3111-7-a M y L ❑Real Property ❑ AnnuallyAssessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract s 07b/9— 5/2-1 D ke Address of mortgagee or contrac Name of assignee or other owne Address of assignee(number ate,4.o...,_.,,__- Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction Fiona?? ❑Yes ❑No on y�ear?r ❑Yes_ 0 N 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 coned and that the applicant is a resident of Indiana and • - 1 contract buyer of the aforementioned property on date application is filed. .. - • . ) Data(month,day,year) ►v 3-a l-I ber o- )IcaA Vt s KZ IP c y]6 ?. o 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 aty,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. .