HomeMy WebLinkAboutMortgage_Land STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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,__��' State Form 43709(R13/10-15)FOR DEDUCTION FROM ASSESSED VALUATION
a : Gibson 2020
Prescribed by Department of Local Government Finance
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File Mark
INSTRUCTIONS:
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)
Kim & Lora Land
Taxing District Key number I legal description Record number Page number
Fort Branch 26-19-18-101-001.147-026 2020
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?
$55,000 p Yes El 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 belov- - - — - - Is the property in question:Annually Assessed
El Real • :.":� ❑ Annually Assessed
Drawer NO 000 ' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
5/3 Bank 3. '
Address of mortgagee or contract seller(number and street,city, Card NO. �-
1-as s
Name of assignee or other owner or holder of mortgage N-\
M C
Address of assignee(number and street,city,state,and ZIP code 1°9\1
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been rsa If yes,state amount of deduction
other county on property for ,,�gAo,S
in Indiana? ❑Yes ❑• No current year? Ws ❑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)
.L..kithS30D Gibson 3/12/2020
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)
Q 3/12/2020
Full resident address of applicant(number and street,city,state,and ZIP code)
906 Mohawk Dr., 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 INDEBT D
Name of applicant Name of mortgagee or contract seller u
Kim & Lora Land 5/3 Bank
Date filed(month,day,year) Amount of indebtedness Taxing District
03/12/2020 $ 55,000 Ft Brancl ifAR
Key number/legal description 2 20�0
26-19-18-101-001.147-026
Signature of County Auditor I County Recorder County Gig h d ear)
Gibson Sphr,
AUDITOR