HomeMy WebLinkAboutMortgage_Holzappel �°---•:'�Q, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
si = FOR DEDUCTION FROM ASSESSED VALUATION
1 t ejli i,- State Form 43709(R13/10-15) Gibson Union '2020
ma • Prescribed by Department of Local Government Finance TRECEIVED -
�-- File Mark
_ o
JNSTRUCTIONS:
To beflfed rn person-or by mail; — U �_1_2�2� F led with
Filing Dates:1)Real Property Mustbe'completed d dated in the-calendaryearforwhich 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) _
Thomas D. Holzappel , Dawn Holzappel
Taxing District Key number/legal description R7I num.- Page num
Union 0 2S:;,,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application I-.- •r equitable owner?
$159,300.00 179,200.00 • '-l'- ❑ No '. '
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with w om
If name on record is different than that of applicant,indicate below: Is e•roperty in question:Annually Assessed
r•6:I Property ❑Annually Assessed -
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �;("+
Fifth Third Bank, National J :'-, : -
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Kingsley Dr. MD:1 MOBA8, Cincinnati, OH 45227 JUL Q 1 2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) �-. .
•
. . • - GIBSON COUIc. , . . ,. , -
Does applicant own property in. 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 'IIE No current year? ❑Yes ❑No
A person is not entitle• 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: -
20 111 I 20 20 20 20 20
Signature of County Auditor County } Date(month,day,year)
611.\M C 3� -7,2. 2 0 2,
I/We certify under the pena of perjury that the above and foregoing information is t and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature wner's full name) Date(month,day,year)
CE:) � N '}`t\ 06/19/20
Full resident address of applica nu r and street,city,state,and ZIP code)
6076 S 50 W, 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. 45109