HomeMy WebLinkAboutMortgage_Adams (6) 0,g.�*-A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
� \t, FOR DEDUCTION FROM ASSESSED VALUATION
I' � State Form 43709(R13/10-15) Gibson 0 22_ 2020
Prescribed by Department of Local Government Finance RECEIVED
INSTRUCTIONS: ^ File Mark
To be filed in person or by mail. 1-Y14 t ' J U L 3 1 20 41-10 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 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)
GARY W.ADAMS
Taxing District Key number I legal description Record number Page number
/
DtN St/I.l��' .c 26-18-06-303-000.339-022 0 ,3/ /
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 equ"table owner?
87,387.00 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 th property in question:Annually Assessed
B Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third Bank,National Association,ISAOA
brand
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ,t
5001 Kingsley Drive,Cincinnati,OH 45227
Name of assignee or other owner or holder of mortgage
AUG 2 0 2020
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in If yes,what county? What Taxing District? omt$ atfc{,agt"` tiffs r iANERTOR yes,state amount of deduction
other county hi fty 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 1 l County \ C ,o^ hate(mg L
10
1/We certify under the penalty of perjury that the above and foregoing information is and correct and that the applicant is a siden of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
(� July 27,2020
Full resident 4ddress of applicant(number and street,city,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
July 27,2020
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 MOR G;GE OR CONTRACT INDEBTEDNESS
Name of applicant . Iva ortgagee or contract seller
GARY W.ADAMS FIL 1 ..- 4'
Date filet more, day,year), n _ Amount of indebtedness Taxing District L �^
Key number/legal description
AUG 2 t.
26-18-06-303-000.339-022 ?/433 5 1 10
Signature of County•igir eounty Recor42/14,C75 dlgnty �O� Date( t day,y ar
GIBSON COUNTY ITO , 20