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HomeMy WebLinkAboutMortgage_Adamson (9) 4N0-"Ate STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS --- CountyTownship Year oi/ � ,., , �.�.a FOR DEDUCTION FROM ASSESSED VALUATION s "f State Form 43709(R14/1-20) Gibson Johnson 2020 � „�'' 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. IZI 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) Christopher& Rachel Adamson Taxing District Key number/legal description Record number Page number Johnson 26-18-33-300-002.272-024 2020 4494 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? $ 137,000 WI 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 ®Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller i)7- Elberfeld State Bank Address of mortgagee or contract seller(number and street,city,state,and ZIP code) /)yol, Name of assignee or other owner or holder of mortgage ,v {� ®eileo 4.4:6 Address of assignee(number and street,city,state,and ZIP code) C )211` NTH Does applicant own property in any If yes,what county? What Taxing District? Has this deduction beay_eduested If yes,state amount of deduction other county on property for /' in Indiana? ❑Yes ®No current year? ®Yes 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 Sign ture of County Auditor County Date(month,day,year) Gibson I I -'-- )'- 5O • 1/We certify under the penalty of perjury that th 'abov nd 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. Si natu (ow er's ful 'amk^ W Date(month,day,year) XVUJfl CW\COYN l i- - OC ll esident address of applicant(number and street,city,state,and ZIP code) 4156 W 1000 S., Ft. Branch, 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 nenalties for neriury can include imprisonment uo to two and a half years and a fine not to exceed$10.000.