HomeMy WebLinkAboutMortgage_Long (4) <s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
61- w FOR DEDUCTION FROM ASSESSED VALUATION
5l'-4'...-y1 State Form 43709(R14/1-20) RECEIVED S1,aN4 02(A tsV
%;e10." Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. L,p p/�,.
\1J"1/4.�• NOV 2 4 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)
Shannon N Long and Monnette Long
Taxing District Key number/legal description Record number_ 26-23-16-100-001.920-024 PMI
Assessed vQr2/
of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid a of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$199,500.00 EYes ❑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: - -f—yl perty in question:Annually Assessed
IL Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank 1\10v 2 4 2020
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
GIBSON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in 9ny 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 ae 20 20 20 20 20
Signature of County Auditor V County Date(mont d ,yea
k " CV L3Q`e\ .4 .
I/We certify under the penalty of perjury that the -.• - •foregoing information is true kspcorrect and that the applicant is a esident f Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
gS'ignature full amal„../-- ,, ` ,�� , Date(�nth day, D-b
Pull ra‘dd applicant(number end street,city,s a e,and 1 code)
Person autorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 1 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.
"T-ram---7-------
RECEIPT FOR FILING STATEMENT OF MOR AGO COlyti R?CT INABTEDNESS
Name liicant Name of mortgagee or contract seller
��Y VIVI 11c3111 Orin e 1‘�vJ NOV 4 2020
Date filed(month,day, ear) Amount o indebtedness Ta 'ng istrict 2
KeyLi Z'A
CD m
pn� SOD! • `^/� It P .� It n ^� ^` M..` 1 N m
L Q Y,� v ,.._
Signature of County Auditor/'I'.n J-eco�er County Date(month,day,year) 0 M
VVI ,
Lcr Tk
LLe- ?ClOY, I b vct Ille.�iJg7?�6