HomeMy WebLinkAboutMortgage_Hartley (10) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
l FOR DEDUCTION FROM ASSESSED VALUATION
0. '• Su:eForm43709(R13/10-15) 7 -. sp 2019
‘,,,, Prescribed by Department of Local Government Finance t J
INSTRUCTIONS: File Mark
To be filed in person or by mail. AUG 2 — ZOis on"Red with:
Filing Dates: 1) 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. . .1 q County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor• tj,:y; -Tan*,
where where the property is located during the twelve(12)months before March 31 of each year theded�iA..rat?e. AUDITOR
See reverse side for additional instructions and qualifications. Ci I Ii 5
Applicant(owner or contract buyer-see restrictions on reverse side)
Michael J. Hartley
Taxing District Key number/legal description .. cord number Pie nurAbgr
White River 26-02-58-031-001.581-018 J�(�/ �t��[v [V
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as a Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
24,000 ❑p Yes 0 No
If no,what is his I 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
El Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
First National Bank of Carmi
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
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 If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on properly for
in Indiana? ❑Yes ONO current year? al 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 fine 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)
,L.:•-±/I.-a Gibson 8-2-2019
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/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
�� 8/2/19
Full resident address of applicant(number and street,city,state,and ZIP code)
8611 N. Cunningham Rd., Hazleton, IN 47640
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$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Michael J Hartley First National Bank of Carmi
Date Ned(month,day,year) 'Amount of indebtedness Taxing District
8-2-19 24000 White River
Key number/legal description
26-02-58-031-001.581-018
Signature of County Auditor/County Recorder County Date(month,day,year)
k,,,,,:.oLki„f,, Gibson 8/2/19