Mortgage_Jacobs c STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
y j: FOR DEDUCTION FROM ASSESSED VALUATION • '
State Form 43709(R13/10-15) Gibson Johnson 2018
c
a_ .. Prescribed by Department of Local Government Finance '
File Mark
INSTRUCTIONS: Form filed with:
To be filed in person or by mail.
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought 0 County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county Where the 0 County Recorder
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 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)
Katherine J. Jacobs ,
Taudr.g District Key number/legal description Record number Page number
Johnson 26-23-15-300-001.505-024 _ 0 I $' - dfo Gel
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the octant the sole
assessment date,current year assessment date,current year date of application or equitable owner?
140 400.00 183,121,00 Yes 0 No
II 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 property in question:Annually AstP«d
Real Property ❑Annually Assessed
FILE 1��lie Home(IC 6-1.1-7)
Name of mortgagee or contract sellers FILE 0 p
Hometown Lenders LLC N�/6
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
310 The Bridge Street 4th Floor Suite A, Huntsville, AL 35806 •
OCT 12 2018
Name of assignee or other owner or holder of mortgage .
Address of assignee(number and street city,state,and ZIP code) .)0hp k
dir
GIBSON COUNTY AUDITOR
Does applicant own property If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on Property for
in Indiana? El 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: I
20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
I/We ce - 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 tract buyer of the aforementioned property on date application is filed. .
Signature er's name) Date(month,day,year)
\LI,12y •
19111118
F ' nt address of app lent(nu and street city,state,end ZIP code) -
2567 Warrenton Road, Haubstadt, IN, 47639
Person authorized by duly executed Power of Attorney or by IC&1.t-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.