HomeMy WebLinkAboutMortgage_Johnson (30) ..E *e�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
c " .;�6 FOR DEDUCTION FROM ASSESSED VALUATION
o.- �); State Form 43709(R14/1-20) Gibson Johnson 2020
;i,--�'' 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)
Christopher D. Johnson
Taxing District Key number/legal description Record number Page number
Johnson 26-19-31-400-001.406-024 &Oa,() .3 7 Lin
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?
$99,000 I 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: iki,tproperty in question:Annually Assessed
frI o c; ❑Annually Assessed
• obile Home(IC 6-1.1-7)
Name of mortgagee or contract seller i �' h
I\
Elberfeld State Bank Drawer O. .I ,Address of mortgagee or contract seller(numb `�`� I OOCT3
Name of assignee or other owner or holder of r
Card NO. J 1 I`((n�` ® ?0?0
Address of assignee(number and street,city,s,ntc,a,ni ur cooe) SON CuU
NT' Ati ,—
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested 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
Sig ature of County Auditor County Date(month,day,year)
m Gibson 10/30/2020
I/We certify under the penalty of perjury t t the abo 74;nd foregoing information is true 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(d0 s full name) �� Date(month,day,year)
Full resident address of applica- number and street,city,state,and ZIP code)
309 W 1025 S, 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)
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