HomeMy WebLinkAboutMortgage_Gengelbach (3) 0E-E-Ak STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship�/-.��� Year
FOR DEDUCTION FROM ASSESSED VALUATION
°I • State Form 43709(R13/10-15) Gibson Johnson 2020
� 1e Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑■ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
William Lee/Libby Ellen Gengelbach
Taxing District Key number/legal description Record number Pag mbar
Johnson 26-18-36-300-002.775-024 (X) 239
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 d application legal or equitable owner?
$ 0,000 ❑■ Yes ❑ No
If no,what is his/her exact share of interest? If owned wii{h someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the prope 'n- uestion:Annually Assessed
El r Pr e ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller -V 3-- ,.
Fifth Third Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 0
'r"Name of assignee or other owner or holder of mortgage .I I 1' iloNk 4CV
Address of assignee(number ands (�V _5 0 _ �j _5 2 '�7 49.m.dG1.11
v�(`( �v �O �rDoes applicant own property in any r J fJ` / is this deducti• ,Sb en eeq `.ted(Sys,state amount of deduction 1
other county Drawer NO property f.r
in Indiana? Yes No rrentyear? ��
❑ ❑� Yes .E—'''
A person is not entitled to this d lortgage or co 't-. indebtedness that is recorded in the county
recorder's office(including any i C a2"d NO• rder's office)that is the basis for the deduction.
Deduction approved in the amount of: - __
20 20 r 2(F-- —-
I I 20 20 20 20
Signature of County Auditor County Date(month,day,year)
oSl aSr tt•, - Gibson 09/16/2020
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 pros-- o to applica on is filed.
Signature(ow ers full ame) / _ ,.� Date(month,day,yeah
I resident address of ap icant(number and street,city,state,and ZIP ode)
re 09/16/2020
1345 W Chukar ollow, 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 neriury can include imprisonment uo to two and a half years and a fine not to exceed$10,000. All