HomeMy WebLinkAboutMortgage_Osmer �.0a N Q, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�( .._. _ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20) Gibson 001 2020
•' „e •° Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Broadway Title/Si mpl i fi l e 11/02/2020 Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the odeduction is sought. lZI 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)
Johnny Ray Osmer and Teresa Ann Osmer, husband and wife
Taxing District Key number/legal description Record number age number
Barton 26-20-02-201-000.790-001 Z0 20 4C`
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?
$133,000.00 1Yes ❑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
l Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank F I LED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
711 Main St., Jasper, In 47546 Nov 02 2020
Name of assignee or other owner or holder of mortgage 1141 •a—^-'--
Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY•�AUDITOR CB
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti�lien requested If yes,state amount of deduction
other countyX
in Indiana? 0 Yes VI No currrentyear?for Yes 0 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
Signatur of County Audi or County Date(month day yea
County
G' son 11/02/2020
I/We certify under the penalty of perjury that the above and 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.
gnatur owners full na e) Date(month,day,year)
jj1.g20 10/29/2020
Full resident address of app icon (number and street,city,state,and ZIP code)
4842 S State Road 57, Oakland City, IN 47660
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS FILED
Name of applicant Name of mortgagee or contract seller Nov 02 2020
Johnny Ray Osmer and Teresa Ann Osmer German American Bank
Qaic/6l�pop2 year) Amount of indebtedness Taxing District ,{{ ^f
1 [�LIjLV $133,000.00 Barton GIBSON COUNTY AUDITOR CB
Key number I legal description —I
26-20-02-201-790-001 ON'O�'� — L,cT 6
Signature f County Audit r/C my Recorder County Date(month,day,year)
�� CB G'son 11/02/2020