HomeMy WebLinkAboutMortgage_Isaacs •
Wit:- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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; County Township Year _
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20)
\1! ✓ Prescribed by Department of Local Government Finance
- - File Mark
INSTRUCTIONS To be fried in person or by mail,.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought ❑ County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable., ❑ County Recorder
See reverse side for additional instructions and qualifications,
Applicant(owner or contract buyer-see restrictions on reverse side)
Stacy Isaacs and Cathy Cay Ogg-Isaacs •
Taxing District Key number f legal description - Record numbtex, -• Pa a number
26-22-12-300-002.688-024 2-01O
Assessed value of real property as of' Mortgage I 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?
$30,000.00 [ 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 that of applicant,indicate below: I-, - r o rty in question:Annually Assessed
tPI -e rr I-rty ❑Annually-Assessed
i' Mobile Home;(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank q, k '_
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) - _
Name of assignee or other owner or holder of mortgage C/eS �COc u
ONC
Address of assignee(number and street,city,state,and ZIP code) OLjvT
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested�' s,state amount of deduction
other county on property for )�O
in Indiana? ❑Yes ®No current year? ®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
Sign lure of County Auditor liz.\ki.... County Date(month,day,year)
I/We certify under th p nalty of perjury that the abov and fo .ing information is true and correct and that the applicant is a resident of Indiana and
owner/co ract buye f e aforementi.`ed" prope IT date -.. cation is filed-
Signature g ® /� Date(Month ay-yea ,
r AAR �A &- - 62de. et !r & ,0 th,e- , Qwwe., ,®'/ 02 o a..zo
Full resi•ant address• applicant(numb-r and Street,city,state,and ZIP code) / /
1250 W 1200 S, Haubs -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)
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 DNESS -
Name of applicant Name of mortgagee or contract sel xr
Stacy Isaacs and Cathy Cay Ogg-Isaacs . German Americarn'
Date filed(month,day,year) Amount of indebtedness T i District
� (� c Ja0 $30,000 ,j (1 p'
Key number legal description 19.
- 4 26-22 12 300 002.688 02 c4$
Sign Lure of County Auditor/Count ecorder County ��' e(month, year)
4AI�N\A.- � Gibson �, � �)
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