HomeMy WebLinkAboutMortgage_Chaddock �`1�="e Or STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.-5— �`�� FOR DEDUCTION FROM ASSESSED VALUATION t'
i;= Gibson 024 2020
��Of,-;. 4• State Form 43709(R14/1-20) RECEWED
a
tale Prescribed by Department of Local Government Finance
OCT 2 2 2020 File Mark
INSTRUCTIONS: To be filed in person or by mail. TaSSC , - Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. ounty 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.
Lisa A. Chaddock
Taxing District Key number/legal description Record number Page number
—14attbstattrT 0 2—Li
l t 24 26-23-16-200-002.483-024/WARRENTON PLACE SOUTH �7ol � �6 3 O
l Assessed value of real propertyas 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 or equitable owner?
$0.00 $178,700.00 's 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 t roperty in question:Annually Assessed
Real Property ❑Annually Assessed
yyy 1 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ITT
`]
Heritage Federal Credit Union I I I. / it f" -
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) -
5388 Old State Road 66, Newburgh, IN 47630 OCT 2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) I • .ty/)----
R/s.
Does applicant own property in If yes,what county? What Taxing District? Has th a tGO U: T(ed.0 0 liTAftstate amount of deduction
other county on property for El Yes ❑ No
in Indiana? ❑Yes NO current year?
A 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 Auditor e57_,
County lDa4( onth,d2y,�ear)
nl,-�h Gibson 1l r"1/4J •
I I We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a res/22—
dent of ndiana and
owner I contract buyer of the aforementioned property on date application is filed. .
Signature wner's ull-:me) Date(month,day,year)
Full re dent a dress of ap/r. t(number and street,city,state,and ZIP code)
1689 E. Lincoln Pas , 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 310.000.