HomeMy WebLinkAboutMortgage_Denning (5) ,a n . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
y:: _ ,„ FOR DEDUCTION FROM ASSESSED VALUATION a
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rb• :`{. State Form 43709(R13/10-15) 1 • 201 g
'e\-_%e' Prescribed by Department of Local Government Finance File ark
ors'
INSTRUCTIONS:
To be filled person or mail. Fdtm filed with:
Dates:
Filing Dates:: 1)Real Properly:Must be completed and dated in the calendar year for which the deduction is sought. )/(�q/\
Must be filed or postmarked with the County Auditor or County Recorder of the county where the
properly is located on or before January 5 of the immediately succeeding calendar year. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ❑ County Recorder
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)
Adam T. Denning
Taxing District Key number/legal description 26-17-04-400-000.209-021 / Record num r Page number
ani I
Assessed value of real properly as of Mortgage I Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
S50,000.00 0 Yes 0 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
0 Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller FILED
Community State Bank of Southwestern Indiana
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
220 S Lockwood St, PO Box 280,Poseyville, IN 47633 •
Name of assignee or other owner or holder of mortgage JUL 1. 2019
Address of assignee(number and street,dry,state,and ZIP code)
nn,'nn�77vv p''IIttllTT�f2
Does applicant own property in any If yes,what county? What Taxing Distrt#.350 Aac M14d1 tl0KbeUr requested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes ❑ No current year? 0 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 e amount of:
20 20 20 20 20 20
r+org�t a of wanly di .r 0 /) Countyo� Date(moot ay,�1\i i under penalty of pe:7?Ntl
that the above and fQrr oing information is true and correct and that the pplicant is resi a of Indiana and
wner/, rtract buyer of the aforementioned property on date application is filed.
na[u nets full name) Date(month,day,year)
j/� �1/Z�� clj
Full r sident ad of applicant(number and street,city, state,and ZIP code)
980 W, Owensville, IN 47665
Person authorized by duly executed Power of Attomey 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$10,000.