HomeMy WebLinkAboutMortgage_Blemker (2) �,I TA•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
,.' State Form 43709(R13/10-15) Gibson Oland 2019
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)
Jerri/Kevin Blemker
Taxing District Key number/legal description Record number Page number
Oakland 26-14-18-201-000.105-007 2019 4403
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?
100,000.00 ❑■ 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 / Is the rope in question:Annually Assessed
.Drawer NO-.., 1 P�.. ❑ AnnuallyAssessedFIIf
Mobile Home(IC ti.1-7)
Name of mortgagee or contract se
Freedom Bank Card NO. qV0
Address of mortgagee or contract NO v 2 0 2019
Name of assignee or other owner Nastc v"
Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY AUDI FOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 0 No current year? 0 Yes ❑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
Signature of County Auditor County Date(month,day,year)
Irn,; Gibson 11/20/2019
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)
t3�„"x„0 11/20/2019
Full resident address of applicant(number and street,city,state,and ZIP code)
905 N Main St, Oakland City, In
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)
Tha nanalties for neriury can include imprisonment uo to two and a half years and a fine not to exceed S10.000.