HomeMy WebLinkAboutMortgage_Heldt (4) 04'AN. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
--- - FOR DEDUCTION FROM ASSESSED VALUATI®�I CE \JED
I\ : ' State Form 43709(R13/10-15) L. Gibson Patoka 2020
�� -V Prescribed by Department of Local Government Finance MAY q 1 2(0
ii File Mark
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INSTRUCTIONS: r�,l '` I1 r �C f 0 .1- 5-11 /2U2p Form filed with:
To be filed in person or by mail. ( w,(, 11 I
Filing Dates:1)Real Property: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 0 County Recorder
property is 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 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)
Jason L. Heldt,
Taxing District Key number/legal description Record,�-� number Pa number
Patoka 26-12-07-103.000.952-028 2 1
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid s of1s'the applicant the sole'
assessment date,current year assessment date,current year date of application I�r l equitable owner?
_ $73,100.00 99,750.00 0 No __
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate withrom
If name on record is different than that of applicant,indicate below: Is propeErty in question:Annually Assessed
eal Pro.e 0 Annually Assessed
--; _"1- Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller L-'1Fifth Third Bank, National I. 3
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Kingsley Dr. MD:1 MOBA8, Cincinnati, OH 45227 MAY 012020
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street,city,state,and ZIP code)
GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes o current year'? ❑Yes ❑No
A person is not entitled tot is 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
Signatw4 County Auditor County- Date(month,day,year)
tuk_
I/We certify under the penalty of perjury that the above and foregoing information Is-rue 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,d y,year)
rbiLD
Full resident address plicant(number and street,city,state,and ZIP code)
429 W Emerson St, Princeton, IN, 47670
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. 44491