HomeMy WebLinkAboutMortgage_Dewig (13) d-`."a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r4 ! FOR DEDUCTION FROM ASSESSED VALUATION
r State Form 43709(R13/10-15) Gibson' Patoka 2018
& I> Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form tied with:
Filing Dates: I) 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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAuditor of the 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)
Brett A. Dewig and Kendra G. Dewig
Taxing District Key number/legal description Re
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/
Gibson 26-11-15-100-003.720-027 �
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Assessed value areal property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indGpedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application I I al or equitable owner?
193,500.00 2nd Mortgage i' Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than s us , .1- :L
It name on record is different that:that of applicant,indicate below: Is thdikeI2 1/'L4kitTanp Annually Assessed
. 0 Real Property Mir Annually Assessed
Mobile Home(IC 6-1.1-7) •
Name of mortgagee or contract seller ,,, ' -�
First National Bank of Carmi Glesory CfUNryAUpt 1 UH
Address of mortgagee or contract seller(number and street,dry,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,dry,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 Fl No current year? CA 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 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.
Signature(owners full name) a - Date(month,day,year)
r, La— %-lk/cl
Full resident address of applicant imber`and street,dry,state,gr: ZIP code)
S44 S C'otiw'fr y( Lou t Y Liz-Th.17 l (ti L-{l(e 70
Person authorized by duly executed Power 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.