HomeMy WebLinkAboutMortgage_Brown (4) ,„, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
401!&1 FOR DEDUCTION FROM ASSESSED VALUATION Gibson Fort Branch 2020
i '"' - State Form 43709(R13/10-15)\ Prescribed by Department of Local Government Finance RECEIVE
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` ^- � J U N 15 2020 File Mark
INSTRUCTIONS: �t/l X- ` Form filed with:
To be filed in person or by mail. �(
Filing Dates:1)Real Property:Must be completed a dated in the calendar year for which the deduction is sought. /L3\ 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)
Elizabeth J. Brown ,Jerry W.Brown
Taxing District Key number/legal description Record number "
Fort Branch 26-19-18-101-000.327-026 2000 �=.�Pq� .-
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?
$202,000.00 176,000.00 0 Yes 0 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
0 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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 •
Name of assignee or other owner or holder of mortgage . •5 `Z02o
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Address of assignee(number and street,city,state,and ZIP code)
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Does applicant own property In any If yes,what county'? What Taxing District? Has this.''IW+tif'".e'-i ..r.A t r WO,state amount of deduction
other county C QV
in Indiana? ❑Yes 0 No ra n year? L J Yes 0 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 Ty I County 1 Date month,day,year)
IIAl iniitt)
I On
We certify under the penalty of perjury that e a . :nd foregoing information is ru and correct and that the applicant Is a resident of Indiana and
owner/contract buyer of the aforementioned pro•- .n date application is filed.
ature(ow sees full m //� Date(month,day,year)
06/10/20
/ Full r ent address of pplic nt(number and sfreeestate,an iP code(�C/)
802E Park St, ort Branch, I 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 nenaltie.e for neriunr can include imprisonment un to two and a half veers and a fine not to exceed$10,000. 44939