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P` i•• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
/,li ` FOR DEDUCTION FROM ASSESSED VALUATION
�s
=.at=FL r, 3�, 3,Fc1'+t Gibson White River 2019
8..�...'.' Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be flied or postmarked with the County Auditor or County Recorder of the county where the property is of
located on or before January 5 of the immediately succeeding calendar year. Lr I County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with.the County Auditor of the county ❑ County Recorder
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)
Mark S. Isaacs
Taxing District Key number/legal description Record number Page number
White River 26-05-58-005-002.318-018/ PT MD 5 1 10 64.22 AC 20(1 93 1-1 1
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?
$0.00 $130,000.00 IX 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 t1 phe property in question:Annually Assessed
Rai-Prot: - 7uAnnually-Assessed__
e f .. , ;,Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller `" `
Farm Credit Mid-America, FLCA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) NOV 0 4 2019
1601 Ups Drive, Louisville, KY 40223
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) GIBBON COtJ,' i'9' ; i .T }
jJS 'i sat#L:3.v`rt-'pe.rty';n an j If yes,what county? What Taxing District? Hasthti deduc.'ti r been requested If yes,state amount of deduction
otr-r :fi n p open for
infix#dtYat?� ❑ Yes tqo R•e-. No
r.ur•F:rSt year? �Yes ���.7
;A person is not en.iitlee`d, to this deduction unless the person has a balance on the person's niort"gage or contract indebtedness that is recorded in the county
recorder's office (t rci-td,.ng any horse equity tine of credit that is recorded ded in Ins county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 10 20 .20 20
Signature of County Ayditort- - ,}.l ���r� County Date(month day,year)
J J )el Kam,=-11� Gibson )1.4't It
I/We certify under 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:eiWri It amp 4L Datg(m tG d/ ar)
Full resident address of applicant(number and street,city,state,and ZIP code) /9 G
6585 N 25 E, 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 perjurry can include imprisonment up to two end a hail years and a fine not to eviceed J f Q.000.