HomeMy WebLinkAboutMortgage_Maynard rSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. 't FOR DEDUCTION FROM ASSESSED VALUATION
j� State Form 43709(R13/10-15) 2019
Prescribed by Department of Local Government Finance File Mark
Ia.
INSTRUCTIONS:
To be filled in person or by mail. Form fled 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 0
property 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 tile with the County Auditor of the 0 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)
Nicholas D. Maynard
Taxing District Key number/legal description 26-19-32-101-000.257-024/605 E Record number Page number
Eisenhower Ln. Haubstadt, Indiana 47639 (� 2 q
26-19-32-101-000.257-024 I a01-1 v `
Assessed value of real property as of Mortgage/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?
528,000.00 ❑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 ❑Annually Assessed
Mobile me(IC 6-1.1-7)
Name of mortgagee or contract seller �t'1
Community State Bank of Southwestern Indiana VWS
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 `
Address of assignee(number and street, city, state,and ZIP code) • %,\CR
T Poo
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested in r. state amount of
other county on property for csoLA deduction
in Indiana? ❑ Yes ID No current year? El Yes Gi 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
Sign ure of County Auditor County Date onth,day,year)
I/We certify under penalty o perjury that ve and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/con ct b r of the aforemenf e property on date application is filed.
S+gnature(or er's f nay pate(month,day,yep
T l(>21•
Full resid nt address applica m er and street,city, state,and ZIP code) 6
605 E Eisenhower Ln., Haubstadt, IN 47639
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.