Loading...
HomeMy WebLinkAboutMortgage_Schmitt (11) 0E2k, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear i''_..�-. FOR DEDUCTION FROM ASSESSED VALUATION a ,fJ; State Form 43709(R13/10-15) GIBSON UNION 2019 *‘4 —'' 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 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. ❑ County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the 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) Jordan T/Kelsey Jo Schmitt Taxing District Key number/legal description -Recor n bee. Page.n �S err UNION 26-19-29-400-002.449-025 .Z l S�S Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mort e 'o ra cries ted npai as of Is the applicant the sole assessment date,current year assessment date,current year date of a li 1 1, legal or equitable owner? I�0 CCO D 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 _ ❑d Real_eroDertv_f_l-Annuallv_Accn....d-- f Ir, i of mortgagee contra.$elleri;f' .e,v a.,,,,,),Th ca-ke)\-0' c),...e Ail ,•,, • f,-, . Address of mortgagee or contract seller(number and street,city,s ,and ZIP code "� l ' Drawer NO...�...J.... Name of assignee or other owner or holder of mortgageV-O. ' 2 32 3 1q Card NO. Address of assignee(number and street,city,state,and ZIP code) {.O 9 Y �,` `1 \�"O V lei: Does applicant own property in any If yes,what county? What Taxing District? Has this d n,bee y,(',,r other county on prop )� - in Indiana? ❑Yes ❑No urr r. I�Yes ❑No A person is not entitled to this deduction unless the person has a balance on the perso 1 II•r4q 'or contract indebtedness that is recorded in the county recorder's office(including any home equity line of credit that is recorded in the count 0 =br's office)that is the basis for the deduction. COUNTY/a1 OR Deduction approved in the amount of: 20 20 20 20 20 20 20 Si na tlCzount�itol ��J � County # o:e(mon ,•ayf�q)i GIBSON 1/'- /2^( 9 I/ e certify under he nalty of perjury that the ove and foregoing information is true and correct and that the applicant is a resident of Indiana and ner/contract buye of the aforementioned property on date application is filed. Sign re(ow is full nam ) Date(month,day,year) F resident address of applicant(number and street,city,state,and ZIP code) 1384 E 950 S, HAUBSTADT, IN 47639 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I 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.