HomeMy WebLinkAboutMortgage_Elpers (33) �.� 74 , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t�.,.$. FOR DEDUCTION FROM ASSESSED VALUATION
�' '�;i State Form 43709(R14)1-20) Gson 024 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. 171 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 faxes 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)
Elpers, Garrett W
Taxing District Key number!legal description Record number Page number
024 26-23-07-200-001.139-024 1 2020 3289
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I 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?
115,000 IZIYes ❑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 ❑Annually.Assessed
Mobile Home(IC 6-1.1-7)
:Name of mortgagee or contract seller
Haub Bank F LED
Address of mortgagee or contract seller.(number and street,city,.state,and ZIP code)
Name of assignee or-other owner or holder of mortgage DEC 1.6 2020
A
Address of assignee(number and street,city,state,and ZIP code) • ,,,a.-
Does
�dIP,Mi COUNTY AUnITOR
Does applicant own property in any If yes,what county'? What Taxing District? Has this d i n een requested If yes,state amount of deduction
other county on property in Indiana? III Yes El No currrenty an for ®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 •' 20 20 20 20 20 20 20
Signature of Auditor County \ Date(month, e
):11)
•
I/We certl under the penalty at the above and foregoing information is tit and correct and that the applicant is a r side tof Indiana and
owner/contract buyer of the aforementioned proopper/ty/on date application is filed.
Signature(owner's full name) Aix �(` !/f/. IDate(month,day,year)
X-77/
I`L) I l,/ �o20
Full resident address of applicant(number and street,city,state,and ZiP ode)'
11397 S 50 E, Haub, 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,stale,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.
RECEIPT FOR-FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Elpers, Garrett W Haub Bank
Date ,filed'(mon dal year) Amount of Indebtedness Taxing District
Lz•I 2`k0 4 , 11 lir'0 dT,. ET
24
Key nu ber/legal description , _., rl ..
26-23-07-200-001.139-024 4 V ?)2,,,g'
Signature of Coun it/County Rpporder Co Date(month, ay, ea
fri C c 16 2020 2 .11 ?A .II
GIBSON COUNTY AUDITOR