HomeMy WebLinkAboutMortgage_Pohl (5) Q.) • STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
° _. FOR DEDUCTION FROM ASSESSED VALUATION
5:__:_
�.: � State Form 43709(R14/1-20) Gibson Johnson 2020
e 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)
Chris A./Patricia M. Pohl 812-664-2275
Taxing District Key number/legal description Record number Page number
Johnson 26-19-31-202-002.128-024 2020-4015
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?
$166,000 ®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
0 Real Property III Annually Assessed
, bile Home(IC 6-1.1-7)
Name of mortgagee or contract seller FIT..., w
Elberfeld State Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
NOV
Name of assignee or other owner or holder of mortgage
1 6 2020
Address of assignee(number and street,city,state,and ZIP code) a
GIBSON COUNTY -?I)n . OR
TP';>^aretb.VrtZ. PICK:1M Yil6T 7 °9 rti:d, ="ii $ T? What Taxing District? Has this deduction been requested I If yes,state amount of deduction
,e�ti.7 fiYfftaf on property for �., r=
atana, ['Yes M No curren, --
A person is not entitled to this deduction unless the person has a balance on the person's mortl V l� I )unty
recorder's office(including any home equity line of credit that is recorded in the county recorde) ',\U) . �t,C/ 4i35
4 5
COUNTY AUDITOR`
e'-/,I rawer NO
Deduction approved in the amount of: a F
•
20 20 20 20 Card NO. —
I 1
Signature of County Auditor County Date(month,day,year)
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.
!0, . :- ��u.``l_POnV_Wn ii )t 1 5) 2-0,
Full resident address of applicant(number and street,city,state,and ZIP code)
188 W 975 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. r
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT IND :. =+ NES � b�-°1�
Name of applicant Name of mortgagee or contra 4V-r , ?
Chris A./Patricia M. Pohl 812-664-2275 Elberfeld State Bank t `w•
Date filed(month,day,year) Amount of indebtedness Taxing District C ``���
$166,000 Johns
Key number/legal description
26-19-31-202-002.128-024 ! A' -•:� _
Signature of County Auditor/County Recorder County ' �'':'- �Q'tti,day,year)
Gibson G\�SO��,L�S�._