HomeMy WebLinkAboutMortgage_Day (4) STATEMENT OF MORTGAGE OR CONTRACT I DN S
Coun Township Year
a FOR DEDUCTION FROM ASSESSED VALUATI
PresPonm 43709 Department ent1 025 2019
Prescribed by Department of Local Government Finance �
INSTRUCTIONS: C+\ File Mark
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To be filed in person or by mail. P „(1c(OR Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which th- • v• Qa!1m.
Must be tiled or postmarked with the County Auditor or County Recorder of th I1 r° • -k e�the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar ye_�asbnf�tA v '
2) Mobile/Manufactured Homes not assessed as Real Property:Must fiitrjWRfie County Auditor of the county ❑ County Recorder
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)
Ryan J Day
Taxing District Key number/legal description Record nun3bgr/1 Page number
025 26-19-21-200-002.170-025/Pt. NE NE 21-3-10 1.95 Ac.-Gibson County I g- �1.13
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,cunent year date of application .- legal or equitable owner?
2111 (-teC El Yes ❑ No
It 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
MI Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
The First National Bank of Allendale
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1515 W Ninth Street Mount Carmel, IL 62863
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 , 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 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.
ignatur fs full name) Date(month,day,year)
/- .. -(o — (®
Full resident address of applicant(number and street,city,state,and ZIP code)
2363 East 750 South, Fort Branch, IN 47648
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,dry state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.