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HomeMy WebLinkAboutMortgage_Besing (6) :,e_tm,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year J"C:,- j= = FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R74/1-20) G'son 003 2020 Prescribed by Department of Local Government Finance ,ors 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. WI 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) Besing, Michael L/Ruby L Taxing District Key number/legal description Record number Page number 003 26-20-02-402-000.052-003 2020 4809 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? $60,000 IZYes ❑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 Haub BankF/LED Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code) Name of assignee or other owner or holder of mortgage DEC 4 2020 Address of assignee(number and street city,state,and ZIP code) Does applicant own property in any If yes,what county? What Taxing District?GIBS i B S ��q rgpµe,�t�l If yes,state amount of deduction in Indiana? Yes No current YesUU�l�rrLLiLJJtttlCfVV(�o in Indiana? ❑ ❑ year? 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 Signature of County d' r County 1 Date ont day, ea IICD .l/We certifyand r the penaltyof perjuryt a e above and foregoing information is t e nd correct and that the applicant is a residen of Indiana and 9 9 owner/contract buyer of the aforementioned property on date application is filed. Signature(owner's full name) Date(month,day,year) `oL-1'atC3vs© ull resident address of applicant(number and street,city,s ,and ZIP code) -/Q1a8 E. j)i 5 O/ a_6/2)Q 47666:3 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 j Date(month,day,year) • Address of authorized person (number and street,city,state,and ZIP code) The nenn/fine,fnr mod,int non inn!,trim,mnricnnmont tin to lum anti a half 1/Pare anti a finp riot to aw'na I.sin nnn.