HomeMy WebLinkAboutMortgage_Graham (2) TATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
f --;: FOR DEDUCTION FROM ASSESSED VALUATION
.,••;t ..... tate Form 43709(R13/10-15) BLc (\
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� ""- /'\ Prescribed by Department of Local G nment Finance RECEIVED
INSTRUCTIONS: YOCO i JUN - 4 2020 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calen year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
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)
Justin Ray Graham
Taxing District Key number/legal description R ord nu ber Pa nu ber
Ft Branch 26-19-18-302-000.361-026 � C7 4 i 0
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 equitable owner?
$121,212.00 0 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 operty in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller A
German American Bank FILE ''' '
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
711 Main St., Jasper, IN 47546 A, 4 202®
Name of assignee or other owner or holder of mortgage ,U 1`t
•
Address of assignee(number-and street,.city,state,and ZIP code) _ } --
nnN COII�TY
AUDITOR
Does applicant.own property in any.. If yes,what county? - What Taxing District? G1BS'has this deduction been requested - If.yes,state amount of deduction
other county • on property for
in Indiana? - -❑Yes 0 No - - -- current year? Otles - ❑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 once(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 r0 20 20 20 20 20
Signature of County Au, County SO_Ali '^ Date(rpO ( , y„t earl
I/We certify under the penalty of perjury t - e above and foregoing information i tr and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig ature owner's full name) Date(month,day,year)
V.,,, 06/01/2020
Full ident address applicant(number and street,city,state,and ZIP code)
406 N Hull St., Fort Branch, IN 47648
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. .