HomeMy WebLinkAboutMortgage_Cooper (5) 0,e^f*•, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
� � FOR DEDUCTION FROM ASSESSED VALUATION
91.`kt`, ;.� i State Form 43709(R13/10-15) G SVf 2020
,;;® Prescribed by Department of Local Government Finance __
File Mark
INSTRUCTIONS:
To be filed in person or by mail. F rm 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 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)
Cooper, Christopher M. & Emily L.
Taxing District Key number/legal description Re ord numb r Page number
Fort Branch 26-19-18-101-001.010-026 oi O c2
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?
260,000 El 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
0 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Springs Valley Bank & Trust Company
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1500 Main St Jasper, IN 47546 31)L s ?on
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) •
LINTY Av�IT..�R
Does applicant own prope in any If yes,what county? What Taxing District? Has this dgg k�han �1n,egquested If yes,state amount of deduction
other county ' on propert?for
in Indiana? ❑Yes 111 • current year? ❑Yes ❑No
A person is not entitled to t is 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
Signature of County Au County Date(mon ,ç
, ear).11
I/We certify under the penalty of perjury that the above and foregoing information'f�true and correct and that the applicant is resi ent of Indiana and
owner/contract buyer of the aforementioned property on date ap lication is filed.
'gnature caner' full narrte) Date(month,day,year)
p�(� 7/3/2020
Full resident addres of applicant(number and street,city,state,and ZIP code) 47
905 Chickasaw Dr 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.