HomeMy WebLinkAboutMortgage_Holzappel 0' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
si i' FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) Gibson Barton 2020
,mow', Prescribed by Department of Local Government Finance
rage
i File Mark
INSTRUCTIONS: Form filed with:
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. ACounty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the 0 County Recorder
property is located oh 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 where the propertyis 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)
Bryan L. Holzappel ,Al sea N. Holzappel
Taxing District Key number/legal description Record Aum,ber 1 a ber
Barton 26420-14-302-000.412.001 ZO
Assessed value of real property as of I. Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the ap licant the sole
assessment date,current year { i ;' ;assessment date,current year date of application le al or equitable owner?
$188,800.00 1 i 237,500.00 /t] Yes ❑ No
If no,what is his/her exact share of interest?i If owned with someone other than spouse,indicate with whom _- ___
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessed
: , Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third Bank, National
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Kingsley Dr. MD:1 MOBA8, Cincinnati, OH 45227 FILED
Name of assignee or other owner or holder of mortgage
.
Address of assignee(number and street,city,state,and ZIP code) - MAR 1-6-2020 --- ' ' -
Does applicant own property in any If yes,what county? • What Taxing District? Has 's deduc• n _ uested If yes,state amount of deduction
other county on•in Indiana? ❑yes izfNo GIB isinb GN ADD l nn 7rk
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 _{ i " j 20 • 20 20 20_ 20
CountyDate(m nth, ay,year)
Signature of County Audi r �11 tk()S e(J lb
I/We certify under the penalty of perjury'that the above and foregoing information is tr and correct and that the applican is a sident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(2ont0 day,year)
,, � 03/12/2
'Fall?esld-nt address of appli nt(numb nd street,city,st ,and ZIP code)
9763 E 700 S, Oakland City, IN, 47660
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
I i
I . ,
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 half years and a fine not to exceed$10,000. - 43926 '