HomeMy WebLinkAboutMortgage_Lamey �4,""' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-4• FOR DEDUCTION FROM ASSESSED VALUATION
`' . Gibson 0 2019
{ i ',„ f' State Form 4370J(R13/10-15) M 1 C l
C
.s,a r0 Prescribed by Department of Local Government Finance
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 deduction is sought. Form filed with:
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 121 Count Auditor
located on or before January 5 of the immediately succeeding calendar year. y
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county 0 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)
Matthew G. Lamey and Katelyn R. Lamey
Taxing District Key number/legal description Record number . Page-rwmber
JOHNSON 26-22-12-300-000.616-024/E SW 12 4 11 3.33 AC 7°ICk 31 f7
- -- -Assessed-value-of-real-property-as of- —_MortgageLContract 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?- - -
$95,200.00 $200,000.00 I es 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 thee roperty in question:Annually Assessed
ItXReal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Heritage Federal Credit Union
i ...,,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) j_dr ..€L i
5388 Old State Road 66, Newburgh, IN 47630 Name of assignee or other owner or holder of mortgage DEC 3'0 2019
Address of assignee(number and street,city,state,and ZIP code)
Does applicantom property in any If yes,what county? What Taxing District? H xc� ,p� ted ' If yes,state amount of deduction
other cou- in Indiana?'eE Yes o °11 -Wcurrent year?r CLJ Yes Y L=TIRIT'�R
A person is not entitled to this deduction unless the person has a balance on the persons 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 i or �t ,� County Datelm nlh,dal',,year)
M11h (,'.. Gibson O M
I/We certify under penalty of pe Iry that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of th aforementioned property on date application is filed.
natuy (o ne u me) \ Da�(m �ay,ye
/ ��
ull resident address of applicant(number and street,city,state,and ZIP code)
1002 W 1200 S Haubstadt, 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S1(),000_