HomeMy WebLinkAboutMortgage_Brown (3) f ri STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
4/,..���,�. County Township Year
`� FOR DEDUCTION FROM ASSESSED VALUATION
2\ ' " > State Form 43709(R13/10-15) Gibson 2020
*'\ "t? Prescribed by Department of Local Government Finance
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File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar 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 Redorder
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)
Keith & Emilie Brown
Taxing District Key number/legal description Record number Page ry mber Fort Branch 26-19-18-101-001.001-026 2020 fnJl�6 '
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?
$179,550.00 ❑■ 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
F T., t ❑■ Real Property ❑ Annually Assessed
. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank JUN 10 2020 6 ,e( , kF V ��
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
i if E`11 i jF A
t r
Wit
Name of assignee or other owner or holder of mortgage ,' r �� ,1.
•
GIBSON COUNTY AU do -a 31_0
Address of assignee(number and street,city,state,and ZIP code)
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 LI No current year? ❑■El Yes ❑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 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 County Date(month,day,year)
J> ll Gibson 06/10/2020
I/We certify under the penalty of perju., that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the afore ••ioned property on date application is filed.
1(
Signatur ow er' full am./ Date(month,day,year)
' 06/10/2020
Full r d of a icant( umber and street,city,state,and ZIP code)
0 ohaw Dr., Ft. B anch, IN 47648
P son authorized by duly execu ed 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)
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