HomeMy WebLinkAboutMortgage_Lupfer d n 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a_- _ FOR DEDUCTION FROM ASSESSED VALUATION /I
} �• Stave Prescribed 43709 Department/10-16) I✓ ' 1 o' I
Prescribed by Department of Local Government Finance J , , I (�V
INSTRUCTIONS: �-'Y 1f ile i�- ft
To be filed in person or by mail. pg. ' 1 'j• a ;gyps':
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be riled or postmarked with the County Auditor or County Recorder of the county where the property is 2 ❑ County Auditor
2
located on or before January 5 of the immediately succeeding calendar year. I I N rill Wounty Recorder
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the courYV
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. ��e
7•+'rµ "
Applicant(owner or contract buyer-see restrictions on reverse side) GlDOs-' - COUNTY /'d!D!TOR
Sara Lupfer,
Taxing
Mo Montgomery number -005.14 IReea(nurnber P`g�,tu;mbetm
Montgomery 26-17-09-200-005.142-021 OC/U ll (JY )YJ\6C1J<
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appli the sole
assessment date,anent year assessment date,current year date of application legal o stable groper?
176,000.00 190,000.00 Yes LJ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate below: Is e property in question:Annually Assessed
J Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Citizens National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
10 W. Elm Street, PO Box 100, Albion, IL 62806
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 yy 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
ner I cunt -• buy-r of the aforementioned property on date application is filed.
-
Sig . ' •wne ull na i e) Date(month,day,year)
1 brd,1 i. 06/19/18
Full resident ad•f-ss o - =nt(number and street,city,state,and ZIP code)
9665 Wi ar. ace, Owensville, IN, 47665
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 310,000.