HomeMy WebLinkAboutMortgage_Pegram (7) 0g RAT.ch STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.
7 ; FOR DEDUCTION FROM ASSESSED VALUATION
'' State Form 43709(R13/10-15) Gibson on 2020
•'� ' 0' Prescribed by Department of Local Government Finance RECEIVED te24
INSTRUCTIONS: ?lov\a,17
OCT022020 File Mark
Form filed with:
To be filed in person or by mail.
' Filing Dates:1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. x County Auditor
Must be filed or postmarked with the County Auditor.or County Recorder of the county where the 0 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)
Nicholas Pegram ,Jalia Pegram
Taxing District Key number/legal description Record number page number
Johnson 26-23-16-100-002.191-024 `Zg2p `_.S2R
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 le I or equitable owner?
$97,455.00 ,288;0'0 I'g0 00 Yes 0 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 e property in question:Annually Assessed ,
Real Property 0 Annually Assessed
Name of mortgagee or contract seller FIL
,,,,my a` Mobile Home(IC 6-1.1-7)
to
First Savings Bank, r-
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
PO Box 22527, Louisville, KY 40252 OCT 0.5 2020
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street,city,state,and ZIP code) 4" i` `
GIBSON COUNTY AUL IP-A
•
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 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 fine 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 ' rrni " C--../)-
County 1 CO� Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is tnde3and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
'nature(owner's full name) Illiph, Date(month,day,year)
/�--� �� 09/24/20
Full resident address of icant(number and street,city,state,T�IP code)
1681 E 1200 S, 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. 46126