HomeMy WebLinkAboutMortgage_Cox (4) .00�",• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
J__, ,11 FOR DEDUCTION FROM ASSESSED VALUATION
9 �.), State Form 43709(R13/10-15) Gibson Haub 2020
°,, ,,.. Prescribed by Department of Local Government Finance
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INSTRUCTIONS: File Mark
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 0 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)
Tammy Cox
Taxing District " Key number/legal description Record number Paggnumber
�Pel�r�e 26-18-36-403-000.101-009 2020 ����jjJJ ��Xfj�J
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unp ibas of Is the applicant the sole
assessment date,current year assessment date,current year date of appl' at l_Q\/'^O(`J�J legal or equitable owner?
arm
.---- ❑■ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someo e 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
■❑ Real Property ❑ Annually Assessed
i
Name of mortgagee or contract sellerr Mobile Home(IC 6-1.1-7)
Quicken la 1,\.�,.• �ti`
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
`
JUL 2 2 2020
Name of assignee or other owner or holder of mortgage
r) X/i
Address of assignee(number and street,city,state,and ZIP code) ,i </r:,
,r r -,. . rm11 r
GIE: ..'. 3 G;UUNTY AUDITOR
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 No current year?❑I I]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)
SS,, Gibson -• 22: 7,j32�
1/We certify under the penalty of perjury 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 aforementioned property on date application is filed.x1Signature owner's full name) Date(month,day,year)
�j�' 07/07/2020
Full resident address Lof applica (numb and street,city,state,and ZIP code)
110 S jeremy Ln, Haub IN
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Tammy Cox unt FI i I ^ Quicken IOOS U.L.
Date filed(month,day,year) m e t " W Taxing District
613.0/28.230 —7• 22 . 2z2•0 . g ICC' • Haub
Key number/legal description JUL 2 2 020 . �7 0(1.0 2�--o�
26-18-36-403-000.101-009 (� .
Signature of County Auditor/County Recorder County Date(month,day,year)
S SM` n/-,s PAt Gibson 7/ 2020
GIBSON COUNTY AUDITOR ZZ