HomeMy WebLinkAboutMortgage_Mulkey m.e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'--4' County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
4' State Form 43709(R131 10-15), GIBBON Johnson I 2019
' Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To befled in person orbymail.
Firing Dates: 1) Real Pro Form filed with:
9 petty: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,
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(Owneror contract buyer-see restrictions on reverseside) •
W(Iham K. /Kristina D. Mulkey
number Page number
Johnson 26-22-09-200-002.734-024 20180,0002182
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assussthent date,current year assessment date,current year
date of application legal or equitable owner?
$139,000 •p' Yes. 0 No
Ifno,what is his/her exact share of-interest?- If owned'ivith 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
0 Real Property ❑ Annually'Assessed
bile Home(IC 6 1.1-7)
Name of mortgagee or contract seller:
Community State 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 2��g
Address of assignee(number and street,cfly'state,end21P code) o�� h
yly11‘ �T OR
Does applicant own property in any If yes,what crounty? What Taxis District? deduction ' AA 14
other county 9 Hasais been request I� tale amount of deduction
in Indiana? ❑✓Yes. Ill No Montgomery on property for•
current year? ❑Yebdele-
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 inrthe county;recorder's:office)-that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved In the amount of:
20 I 20 I 20. l I 2 I
0 20 20
I I 20
r� i
Sig _ .ofCountyAuditor County
v/�/t/�cp Z I Date(month,day,'year)
Gibson. /a /e"/g
/We certify u er enalty of perjury that the ve and foregoing information is true and Correct and that the applicant isa resident of Indiana,and
owner/contract buyer of the aforementioned prop rty on date application is,filed.
Signa re,(owner'sfutlnam'e) / /rzy4�
' ,��lsyfF R - Date(month day yea
Full sident address of applic�nt(numb an sheet,city,state,and ZIP code) '
3433 W SR 68, Haub dt, IN 47639
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)
I
The penalties'for perjury can include imprisonment up to two and-a halfyears and a fine not to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 'Name of applicant I Name of mortgagee or contract seller
William K. /Kristina D. Mulkey Community-State Bank Date filed(month,day,year) Amount of indebtedness
Taxing District i
$1'39,000 Johnson Key number/legal description
26-22-09-200-002.734-024
Sign r f County Auditor unty Recor er County
/(- Date(Month,day,year) ,
l / GIBSON /2_18_/9
l