HomeMy WebLinkAboutMortgage_LLC (16) •4e" , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
„ ; i FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) Gibson Fort Branch 2020
``""g
refa Prescribed by Department of Local Government Finance RECEIVED
SEP 0 3 2019 File Mark
INSTRUCTIONS: Q S- I Form filed with:
To be filed in person or by mail"
Filing Dates:1)Real Property:Must be co pleted and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the County Recorder
property is 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 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)
G&K Properties LLC
Taxing District Key number/legal description Record number Page 'b
Fort Branch 26-18-13-403-000.050-026 20, 3 .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant t e:sole
assessment date,current year assessment date,current year date of application •• or equitable owner?
$55,700.00 60,000.00 ' es 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with wh•m
If name on record is different than that of applicant,indicate below: I-the property in question:Annually Assessed
4.eal Property 0 Annually Assessed
hMobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Field & Main Bank IL Y.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1020 N. Burkhardt Rd, Evansville, IN 47715 SEP 0-g 2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) �f
• GIBBON COUNTY AUDITOR -
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state arhount of deduction
other county on property for
in Indiana? ElYes No current year? ❑Yes ❑No •
A person is not entitled t 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 Auditor County 1 Dat onth,day,year)
rim 0� So'1 04 3
I/We certify under the enalty of perjury that t e above and foregoing information is t and correct and that the applican is a esident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signat owner's full name) Date(month,day,year)
I' wciLj,),(--- 08/21/20
Full resident address of applicant(number and street,city,state,and ZIP cod
306 W Strain St, Fort Branch, IN, 47648
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. 45904