HomeMy WebLinkAboutMortgage_Smith (23) �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Mau nship Year
t FOR DEDUCTION FROM ASSESSED VALUATION
Sl ' State Form 43709(R11/6-09) GIBSON =r r.e 2018
;ace Prescribed by Department of Local Government Finance
O, ile Ma .qr
INSTRUCTIONS: �.'�{�
To be filed in person or by mail. Cijen`' , Forril eed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sodyryf, 4-p3nry Auditor
Must be fled with the County Auditor or County Recorder of the county where the property is loca�@B ,
on or before January 5 of the immediately succeeding calendar year. COG 'W U County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the til "''v
county where the property is located during the twelve(12)months before March 31 of each year the },9G
deduction is sought. Qy
See reverse side for additional instructions and qualifications. lOrs
Applicant(owner or contract buyer-see restrictions on reverse side)
RYAN J. SMITH &JACQUELINE N.SMITH
Taxing District Key number/legal description Record number Page number
MONTGOMERY 26-17-08-200-001.668-021 o1-0 18
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,current year date of application legal or equitable owner?
164,400.00 0.00 110,000.00 0 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 ❑Annua yAsses Horne sMobil 6-1.1-7)
Name at mortgagee or contract seller
FIRST NATIONAL BANK OF CARMI
Address of mortgagee or contract seller(number end 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?
❑ yes ❑ No ❑ 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/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
�prrr�/ooppeertty on date application is filed.
Signature(� full na ) A ztets'r u fi. Date(month,day,yead
/[/O IV. 1a -31 - 1�
Ful re anti dress of applicant(n ber street,city,state,and ZIP code)
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)