HomeMy WebLinkAboutMortgage_Kohlmeyer (4) os,,,,,s7"144 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ct, FOR DEDUCTION FROM ASSESSED VALUATION
�v:- �6d Gibson Patoka 2020
� _ � State Form 43709(R13/10-15)
'+\mod Prescribed by Department of Local Government Finance p
.a,. RECEIVED
File Mark
•INSTRUCTIONS: TCAPINAL�, JUN - 8 2020 Form filed with:
To be filed in person or by mail.
Filing Dates: 1)Real Property:Must be comrnated 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 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) .
Joshua A. Kohlmeyer, Shannon R Kohlmeyer
Taxing District-, Key number/legal description Record m er Page nulpb �
Patoka V.)S. • 26-12-05-400-001.091-027 • 1(J ,Assessed value of real pr perty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness u ai as of Is the applicant the sole
assessment date,current year assessment date,current year date of application le or equitable owner?
221,400 215,625.00 es 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with w m
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessed
eal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 1
German American Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
711 Main Street, PO Box 360, Jasper, IN 47546 FIL n .9.,
h
Name of assignee or other owner or holder of mortgage I
Address of assignee(number and street,city,state,and ZIP code) JUN II 0 2020
Does applicant own property' , y If yes,what county? What Taxing District? Has this d tt equesed--if yes,state amount of deduction
other county o 144.::�
in Indiana? ❑Yes o c rn n CITY 1917
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 0 ca(3,7_20 20 20 20 20
Signature of County Audito County \ Date( nth,day,year)
I/We certify under th penalt of perjury that the above and foregoing information is ru and correct and that the applicant is a residefit of Indiana and
owner/contract buyer of th aforementioned property on date application is filed.
Sign re( ner's fyll nam ) p q \ oI2o
Date(month,day,year)
Full re dent address of applicant(number and street,city,state,and ZIP code)
12 4 E Taftown Rd, 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. 44956