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+e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�`��= aunty Township Year
"3.- FOR DEDUCTION FROM ASSESSED VALUATION
� .• ( ) RECEIVED ��or) 9a-+ 7j2'0�••a State Form 43709 R13/10-15.".a' Prescribed by Department of Local Government Finance
INSTRUCTIONS: I JUL 3 12019 File Mark
To be filed in person or by mail. !I L�'0 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in th lender 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.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
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)
Taylor M. Maurer and Summer L Maurer, husband and wife
Taxing District Key number/legal description Record number Pa a number
a 0 2 7- 26-12-05-400-000.684-027 1020 16 C
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?
$144,238.00 E 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
German American Bank FILED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
711 Main St., Jasper, IN 47546
Name of assignee or other owner or holder of mortgage JUL 312020
Address of assignee(number and street,city,state,and ZIP code) IRLI _ / m'--
•
Does applicant own property in any If yes,what county? What Taxing District? s'fhs de-ductioonb en req est�eaT®Ifyes,state amount of deduction
other county on property for
in Indiana? ❑Yes No 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 of County Aud 11, • County Date(month,day,yeah
j'rvt; CC3,a,)I/We certify under a penalty of perjury ttrate 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.
Signat fu name) Date(month,day,year)
-4 07/28/2020
esident address of applicant(number and street,city,state,and ZIP code
1256 E Taftown Rd., Princeton, IN 47670
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.