HomeMy WebLinkAboutMortgage_Cole (2) SSE *F STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
r...-'=..-- FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
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i' 't tj� State Form 43709(R14/1-20) Gibson Patoka 2020
ie,e�. Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Form filed with:
Filing Date: Form must be completed 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 property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jared W/ Kathryn S Cole
Taxing District Key number/legal description Record number Page number
Patoka Township 26-11-16-200-004.700-027 2019 4258
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?
$140,600 $109,117.58 $100,000 JYes ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
N/A N/A
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
N/A ®Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller w
21st Mortgage Corporation Ef Er)
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ...,
620 Market St STE 100, Knoxville, TN 37902
Name of assignee or other owner or holder of mortgage JUL 1 4 2020
N/A
Address of assignee(number and street,city,state,and ZIP code)
N/A )1444--‘—'
Giss�Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been reques a gW,/it(ife a�o pftd.eduuction
other county on property for 1
in Indiana? III Yes ®No N/A N/A current year? ❑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 tyAp ditor // County Date(month,day,year)
I/We certify un er the penalty of pe4jthat the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig ature(owner's full name) Date(m nth,d y,year)
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Full sident a re of applicant um er and street,city,state,and ZIP code)
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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.