HomeMy WebLinkAboutMortgage_Sisk (7) ottfro'a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS aunty Township Year
• : ,. , FOR DEDUCTION FROM ASSESSED VALUATION 1
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"_ !"' State Form 43709(R13/10 15) 4 h 2020
"o .+__.er` ' Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS: p
To be filled in person or by mail. eC J Form filed with:
Filing Dates: 1)Real Property:Must be completed and ted in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the 17
property is located on or before January 5 of the immediately succeeding calendar year. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ❑ County Recorder
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)
Austin Sisk and Haley Sisk
Taxing Dist( Key number/legal description 26-19-19-101-000.619-026/409 E. Strain Red
nuumbber Page number
�( St., Fort Branch, Indiana 47648 LJQ'O Lit q
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 r quitable owner?
$212,000.00 y es 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom _.
If name on record is different than that of applicant,indicate below: Is the property in question: Annually Assessed
eal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller '
Community State Bank of Southwestern Indiana IE ` _
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
220 S Lockwood St, PO Box 280, Poseyville, IN 47633
Name of assignee or other owner or holder of mortgage O C T 1 G. 2020
Address of assignee(number and street,city,state,and ZIP code) 'Is
'
W � •
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requegti"3SON �If ya�','$'tate amount bf
other county on property for deduction
in Indiana? El Yes ,'�lo current year? 0 Yes 0 No
his`de A person is not entitled todeduction 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
Sign a of County Auditor County . Date(month,day,year)
irk6&P . io/et�z29zo
1/ e certify under penalty of pei(i ry that the above and foregoing information is true and correct and that the appli nt is a resident of Indiana and
owner/contract buyer of thee aforemention d property on date application is filed.
Signature(ow).,-,`s full name) / I D te(month,day,ye j
Rull residen a.dress of applicant(number and street,city,state,and ZIP code)
409 E 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.