HomeMy WebLinkAboutMortgage_Rexing SEE".•.q. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
k FOR DEDUCTION FROM ASSESSED VALUATION
� d)' State Form 43709(R14/1-20)
�' Prescribed by Department of Local Government Finance Gibson Fort Branch 2020
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)
Alan Michael Rexing e OO 3 — `-k grj
Taxing District Key number/legal description Record number Page number
Fort Branch Mi419-19 -a0A-00)-®382'1 -oaLe,
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 or equitable owner?
$104,000.00 I 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
- - - 'ir1':, I Property ❑Annually Assessed
,�% .y �ff J Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller '��-�a!� ,:'
Elberfeld State Bank Drawer NO• afA
Address of mortgagee or contract seller(number and street,i •• ••••• •' ,,.q
Name of assignee or other owner or holder of mortgage C a 1 d 1�T O• .. / ` 2020
Address of assignee(number and street,city,state,and ZIP code) •►j
_�NTy *7
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been reques404fyes,state amount of deduction
other couty III ®No on property for
in Indiana? current year? ®Yes ❑No !//__
�R
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
Sig lure of County Auditor County Date(month,day,year)
. 0 Gibson 10/29/2020
1/We certify under the penalty of perjury that e aboia d foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementio -e property on date application is filed.
Signal ers full nam Date(month,day,year)
,�!rs � . ^ - •� 1®-Qc -0Oao
Full resident address of applicant um.. . d street,ci , ate,and ZIP code)
405 N. Eastview St., Ft. Bra , 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)