HomeMy WebLinkAboutMortgage_Conway _451. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r ` FOR DEDUCTION FROM ASSESSED VALUATION
�f; State Form 43709(R1411-26) Gibson Johnson 2020
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed In person or by mail. Form Red with:
Filing Date Form must be completed and dated In the calendar year for which the deduction Is sought. 121 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)
Michael W. & Lisa A Conway
Taxing District Key number/legal description Record number Page number
Johnson 26-22-12-300-002.061-024 2020 3a.
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sal
assessment date,current year assessment date,current year data of application legal or equitable owner?
$ 183,500 giYes ❑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
First Federal Saving Bank
Address of mortgagee or contract seller(number and street,oily,state,and ZiP code) , i
SFp
Name of assignee or other owner or holder of mortgage 01
Address of assignee(number and street,city,state,and ZiP code) Oho
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N en
Does applicant own property in any It yes,what county? What Taxing District? Has this deduction 71if d ,state amount of deduction
t conty on property for
o 1'
InherIndianeu? El Yes VINO current year? 0Yes
A person Is not entitled to this deduction unless the person has a balance on the person's mortgage or contract Indebte rfel1hatls recorded in the county
recorder's office(Including any home equity tine of credit that Is recorded In the county recorder's office)that/s the bests for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signa a of aunty Auditor County Date onfh,*ye,year)
Gibson —1--1_cc00
I I We certify under the pena o perjury that the ab ve an regoing 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(o nets ui/name) , .. Date(monthY
da year)
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Full resident address of applicant er end street,ci ,state,an ZIP code)
11754 S 150 W, Haubstadt, IN 47639
Person authorized by duly executed Power o1 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 penury 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 C•; RA s EBTED NESS
Name of applicant Name of o gagee.; -'• '•...'liar
Michael W. & Lisa A Conway F er 'IL-wing Bank
Date filed(month,day,year) Amount of Indebtedness _Tqkkie District
$ 183 0
10.1\9dhnso ,
Key number/legal description 0
26-22-12-300-002.061-024 dk
Sign lure of County Auditor/Cau ecorder Pike JD• County vQbbte(moor da r) ,zij -
Gibson (''b{ «</'
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