HomeMy WebLinkAboutMortgage_Klem . �- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
44'. ,'�,,� FOR DEDUCTION FROM ASSESSED VALUATION 3�� Q 24 2020
State Form 43709(R14/1-20)
4t,, , ` Prescribed by Department of Local Government Finance File Mark
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INSTRUCTIONS:
To be filled in person or by mail. led with:
Filing Dates: Form 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 located on or before January 5 of the calendar year in which the property taxes ae first due County Auditor
and payable. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Tammy Klem
Taxing District 0 Key number/legal description 26-19-19-101-000.388-026/ Record number Page number
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 leg r equitable owner?
$132,000.00 Yes 0 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 a property in question: Annually Assessed
R al Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Community State Bank of Southwestern Indiana
14. A
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ., . ,.
220 S Lockwood St, PO Box 280, Poseyville, IN 47633 NO/,
Name of assignee or other owner or holder of mortgage <8 e . ,
G'-6',s, %'S e�,0
Address of assignee(number and street,city,state,and ZIP code) A/C,
O4/
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction be ste If yes,state amount of
other county on property for '9(/0 deduction
in Indiana? ID Yes 0 No current year? s No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co tract i debtedness 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
Sign ure of County Auditor County L Date(month,day,year)
\r-CL-\i\A. i IS a— (1. — — CO- a
I/We certify under the pe alty of perjury ha he above and foregoing information is true and correct and that the applicant is a resident of Indiana
and ow ntract buyer of the afor - ntioned property on date application is filed.
�igga ure(o nee ull ) 1-1--46.z.)
Dlletionth_day yeai
F✓ulullllrresiden ress of applica be n strreet,city,state,anIP code) /vlyll G
600 S Lincoln St., Fort B nch, 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.