HomeMy WebLinkAboutMortgage_Lamey (18) 07'k STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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„; y,= FOR DEDUCTION FROM ASSESSED VALUATION
:,St -/- State Form 43709(R14/1-20) RECEIVED Gibson Johnson 2020
, me Prescribed by Department of Local Government Finance _I
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-}le_ - 3 2020 File Mark
INSTRUCTIONS: To be filed in person or by mail. �" C Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. RE 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)
Matthew G. Lamey and Katelyn R. Lamey
Taxing District Key number/legal description Record number Page number
-4446alatarit 3(.3 h 26-22-12-300-000.616-024/E SW 12 4 11 3.33 AC 2o2-e 2-o"13
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 e able owner?
$200,000.00 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: • Is th- .roperty in question:Annually Assessed
P Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller e
Heritage Federal Credit Union 4
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5388 Old State Road 66, Newburgh, IN 47630 JUN 0 q
Name of assignee or other owner or holder of mortgage 3 L020
Address of assignee(number and street,city,state,and ZIP code) 4 i -
Does applicant own property in any If yes,what county? What Taxing District? as this ae'auLTionsbetmrEg9tigtarroFif yes,state amount of deduction
other county CI Yes El No on property for El Yes El 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 Audi s County Date nth, ay,year)
wl‘ (-nap
m Gibson 6 `- 27 O
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resid nt f Indiana and
owner/contract buyer of the aforementioned property o date application is filed.
Aim ji_.
Sig tore. nersiu a p � „ z ,_ Date\r/a5INst
Full resident addre of applicant(number and street,city,state,and IP code)
1002 W. 1200 S., 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 two and a half years and a fine not to exceed$10,000.