HomeMy WebLinkAboutMortgage_Lamb (2) �6�•�4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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, FOR DEDUCTION FROM ASSESSED VALUATION
Gibson 2019
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deductic �0 .�Il
Must be filed or postmarked with the County Auditor or County Recorder of the county v Drawer NO
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County
where the property is located during the twelve(12)months before March 31 of each yew —
See reverse side for additional instructions and qualifications. Card Nr O.
Applicant(owner or contract buyer-see restrictions on reverse side) •
Joshua/Rebecca Lamb I Q0,000•
Taxing District Key number/legal description rnoom
Fort Branch 26-18-13-404-000.874-026 aTlJy 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?
$120,000 ❑■ Yes ❑ 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
I] Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage 1°
WIN
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 reques d atihOil
duction
other county on property for Okiin Indiana? El Yes ❑� No current year? ❑Yesobp1
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contracW ebtedness 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
Signature of County Auditor County Date(month,day,year)
tSA-I2m.1-1:1z,Jxt Gibson 11/07/19
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)
11/07/19
Full resident address of applicant(number and street,city,state,and ZIP code)
105 N. Main, Ft. Branch, IN 47648
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
Joshua/Rebecca Lamb German American Bank
Date filed(month,day,year) Amount of indebtedness Taxing District
11/0719 $120,000 Fort Branch
Key number/legal description
26-18-13-404-000.874-026
Signature of County Auditor/County Recorder County Date(month,day,year)
Gibson 11/07/19