HomeMy WebLinkAboutMortgage_Nunez-Salemie �rs, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
7' = r FOR DEDUCTION FROM ASSESSED VALUATION
a�.. .:k State Form 43709(R14/1-20) GIBSON Union 2020
"�7ei6-v. Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed 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 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.
Applicant(owner or contract buyer-see restrictions on reverse side)
Kristina M. Nunez-Salemie
Taxing District Key number/legal description Record number Page number
Ft. Branch 26-19-18-304-000.978-026 ,.-9/5
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 pi application legal or equitable owner?
$80,000 ZYes ❑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,Indic Is the property in question:Annually Assessed
Mj 1 ' E�_5 ^ - ®Real Pro perty(Tr +■ ugly6
U J a M bilelye(IC Assessed 6-1.1-7)
Name of mortgagee or contract seller
Haubstadt State Bank l0-51 PI V11,4 -,,
-
Address of mortgagee or contract seller(number and st
:10- 41q�a our 2 32020
Name of assignee or other owner or holder of mortgage .
iri :
Address of assignee(number and street,city,state,and ZIP code) lO TOR
IQ ON COUNTY �'
Does applicant own property in a If yes,what county? What Taxing District? Has this deduction been reques ed If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? ['Yes ❑No
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
Sign o County Auditor Q County Date(month,day,year)
YV �' `�r GIBSON 10/23/2020
C I We certify under the penalty of perjury that above and foregoing information is true and correct and that the applicant is a resident of Indiana and
wner/contract buyer of the aforementione perty on date application is filed.
>Zgna r (owner's f 1 r ameY ) Date(month,day,year)
!//t/�,1,/�[� 10/23/2020
Fu resident address of applicant(number and street,city,state,and ZIP code)
104 N. Hull St., Ft 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.