HomeMy WebLinkAboutMortgage_Ziliak (7) �0- ., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSCountyTownship
�'� Year
.;, r�� FOR DEDUCTION FROM ASSESSED VALUATION
7'" 't"-h State Form 43709(R14/1-20) Gibson Johnson 2020
' �ei
" d 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. Z 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)
Jonathan D. & Laurie M. Ziliak
Taxing District Key number/legal description Record number Page number
Johnson 26-22-14-300-000.994-024 2020 0 0 vl lQ
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?
$445,000 21Yes ❑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
J,•-1 roperty ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller k /r
n`
Old National Bank 40
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 141/
6 2:�2
Name of assignee or other owner or holder of mortgage 020
Address of assignee(number and street,city,state,and ZIP code) V'/BS0N r,�,\
N Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested
sst If ydCiete)aOmount of deduction
in er Indiana?
®Yes ❑No Gibson Johnson on propertcurrent year?
® ❑ R
in Indiana. 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
Si ature of County Auditor County Date onth,day,year)
J1 \, Gibson - �1-- ,
J
I/We certify under the penalty of perjury hat t di:bove and foregoing information is true and correct and that the applicant is a resident of Indiana and
r offer/cor t a buyet of the aforementioned . .•erty on date application is filed.
Si'k re(owner i full name) . Daiilit o 1,711y,y ar)_
art - =11.�/ (11�1� _ 1 � l 'y
Full re•gent address of applicant(number and street,city,state,and ZIP code) (�
12620 S. Scottsdale Dr., Haubstadt, IN 47639
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
Jonathan D. & Laurie M. Ziliak Old National Bank f � a
Date filed(month,day,year) Amount of indebtedness Taxing nct t,
,t
g'- _ ac'� $445,000 Johnson
Key number/lescription
26-22-14-300-000.994-024 AUG 2''� 202�
Si ture of County Auditor/ unty Recorder County ate(month,day,year)
I AiLdj
Gibson pi'
�gSON COUNTY/6LU®ITOR