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HomeMy WebLinkAboutMortgage_Phillips (4) ,0-,:w.t, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year °'' ---2,...-=4\10 FOR DEDUCTION FROM ASSESSED VALUATION i '1� Gibson Columbia 202,0 �, ,,, State Form 43709(R13/10-15) '•`eitia` 'I Prescribed by Department of Local Government Finance INSTRUCTIONS: d� lO `�S� File Mark To be filed in person or by mail. J V S `� " Form filed with: Filing Dates: 1) Real Property:Must be completed and dated in t calendar year for which the deduction is sought. Must be filed or postmarked with the County Audit r or County Recorder of the county where the property is ❑✓ County Auditor located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder 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) Nathan J and Shay C Phillips Taxing District Key number/legal description Record number Page dumber Columbia 26-14-20-200-001.582-006 aO �/ti Assessed value of real property as of Mortgage I 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? $290,000 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 LNB Community Bank Id Address of mortgagee or contract seller(number and street,b st e, d ZIP'o a 111 +� , Name of assignee or other owner or holder of mortgage OCT 15 2020 • Address of assignee(number and street,city,state,and ZIP code) Does applicant own property in any If yes,what county? t? Has this deduction been requested If yes,state amount of deduction Intlndiana? ❑✓ No GIBSOIN COUNTY AUDITOR onpropertyfor $3 000 ❑Yes current year? ❑✓ Yes ❑No $3,000 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 Signature of County Au c..AL (63i) County 1 Date(month,day,year) 1/We certify,under e penalty of perjury that the above and foregoing information is We 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(owner's full name) ' Date(month,day, ear) /p ��'''' Full resident address of ap ' t(nu er and street,city,state,and ZIP code) 1550 S 1300 E Oakland City IN 47660 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.