HomeMy WebLinkAboutMortgage_Wilkerson (2) 40, "ts. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year -
ilk ice;..
FOR DEDUCTION FROM ASSESSED VALUATION
Gibson 0 2020
State Form 43709(R14/1-20)
Prescribed by Department of Local Government Finance -
File Mark
INSTRUCTIONS: To be filed 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. XCounty 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)
Jason H.Wilkerson
Taxing District Key number/legal description Record number Page number
Princeton 26-19-31-300-000.119-009/PT NE SW 31-3-10 .7215 AC 2-0 20 [6 2.3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I 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?
$0.00 $224,800.00 ❑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: Is the property in question:Annually Assessed
❑ Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller F IL
German American Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
PO Box 360,Jasper, IN 47547-0360 MAY 0 4 2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) irMVE 1
•
GIBSON COUNTY AUDI OR
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 El Yes ❑ NO on property for ❑ Yes ❑ No
in Indiana? current year?
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 t County Date(month,day,year)
rh 6e, Gibson 2-1:fjJo
I I We certify under penalty of perjury that e above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contact buyer of the aforementioned property on date application is filed.
Signa s full na ) / ® ateymonth,dayyyear)
F resident address of applicant(number and street,city,state,and ZIP code)
403 E. Gibson St., 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 tvio and a half years and a fine not to exceed$10,000.