HomeMy WebLinkAboutMortgage_Jolly 40-„,,'!tea STATEMENT 0 =-- -- --___.`�_:-.�._ . _ .. ------- - - EDNESS
�"4 � - —"'--v"' County Township Year
/1.���< FOR DEDUCTII .
i!_�,,.% ..t)r State Form 43709(R131 Gibson Hazleton 2020
�,m-d Prescribed by Departs Drawer NO.... ..... '
File Mark
INSTRUCTIONS: '
To be filed in person or by mail. 1�_� Form filed with:
Filing Dates: 1) Real Property:Mus Card NO. 1 ?deduction is sought.
Must be filed orpos county where the property is ❑■ County Auditor
located on or before ❑ County Recorder
2) Mobile/Manufactui e County Auditor of the county
where the property is rocarea Gunny me rwerve(ICJ rlwrru1J uwure,V,a,1,„,, li,each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Michael & Karen Jolly
Taxing District Key number/legal description Record number Page number
Hazleton 26-02-49-101-000.178-019 2020 1 '") r]4
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?
$20,000 ❑p 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
❑■ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union -- Contact Seller is Kim (Beadles)and W n ' in er ,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
' ..1)
Name of assignee or other owner or holder of mortgage VG 2
?020
Address of assignee(number and street,city,state,and ZIP code)
Al
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been rccf u % , ,state amount of deduction
other county on property for
in Indiana? Yes No current year?CI ❑�
Yes ❑No '9 UQ/-,. Ap
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that isOr@torded 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)
.A- 1- / Gibson 08/20/2020
I/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.
Signature(own s full name m Date(month,day,year)
X v/J 08/20/2020
Full resident address of applicant(number and street, ty,state,and ZIP code)
611 E. Center St., Hazleton, 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 nenalties for neriuni can include imnrisonment un to two and a half years and a fine not to exceed. 10.000.