HomeMy WebLinkAboutMortgage_Cushman , giros. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
a- Gibson FOR DEDUCTION FROM ASSESSED VALUATION I rl I 2019
n i
State Four.e3=.?y(F,7&/h}13i
, `• Prescribed try Department of Local Government Finance
INSTRUCTIONS: File Mark
To oe filed in person or by mail Form filed with:
Filing Dares: 1) Real.FNperr:Must be completed and dated in the calendar year for which the deduction is sought. ❑x County Auditor
Must be fled or postmarked with the County auditor or County Recorder of the county where the property is
located on or before January 5 of the InunediateN succeeding calendar year ❑ County Recorder
2) Mobile f Manufactured Homes not assessed as Rea/Proper,:Must file with the County auditor of we county
where the Draper:is fixated during the a:-Ne t i 21 months before March ?t 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)
Tyler C.Cushman
Taxing District Key number/legal description Record number Page i n mbet
Fort Branch 26-19-19-103-000.377-026/LOWES ADD 1OPT 2-l`/J� 11 3 G/_
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?
$118,495.00 ID 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
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
Ruoff Mortgage Company, Inc.
Name of assignee or other owner or holder of mortgage AUG 1 3 Z019
Address of assignee(number and street.city,state,and ZIP code) _
D.es applicant e v l croxrty m any If yes.what county? What Taxing District? Has ttds d 'y•r` If yesfstate amount of deduction
cserc:un:i unwtaprIBSQId`�d�llixl"i r
inbneuna? ❑'yes NNo current year? Dyes NO
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 ecu:ty line of cede that is recorded in the county recorder's office)that is the basis for the deduction_
COUNTYAUDITOR
Deduction approved in the amount of:
2i1 1 I 20 20 "/il 20 'Ift I 7ii
Signature of C r u I for-}(,, CID CountyD (np ea
g . 1" ` �J� Gibson
I tX, I`
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a res dent f Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature(owner's tuff name) Date(month,day,year)
O3iy,tA -- L C✓4 — IQ lei I C!
Full resident address of applicant(number and street,city,state,and ZIP code)
1012 S Center Street, Ft Branch, IN 46848
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 peciu.•y can include Imprisonment up to two and a hair years and a fine not to exceed 570,000.