HomeMy WebLinkAboutMortgage_Besing ,, " e , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cqunty Township Year
:44 FOR DEDUCTION FROM ASSESSED VALUATION Ie
y g' State Form 43709(R14/1-20) �)'J fl O 2020
..•.., " Prescribed by Department of Local Government Finance ' File Mark
tale ,.
INSTRUCTIONS:
To be filled in person or by mail. For filed 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)
Brooke Besing and Lance Allen
Taxing Di Key number/legal description 26-18-36-402-000.335-009/106 N. Hull St., Re • d number Page number
O - Haubstadt, Indiana 47639 la" i 5. 3
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 le equitable owner?
$173,992.00 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with who
If name on record is different than that of applicant,indicate below: s ILro^ in c - . : Annually Assessed
, t=.A a 'nnually Assessed
M•bile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 2�2�
German American Bank DEC 4
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
711 Main Street, P.O. Box 360,Jasper, IN 47547 ()I •
Name of assignee or other owner or holder of mortgage �t`4" UDlTO
GIBSON C K
OUNTY A
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any 1 If yes,what county? What Taxing District? Has this dedu ion een requested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes El No current year? Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co tra f 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) hat i the basis for the deduction.
COUNTY AUDITOR
Deduction approved in t amount of:
•
20 20 20 ( 20 20 20 20
Signature of Cou Au 'tor .4\ County ` Date(mot d ,yea _^ .
I/We certify un er e penalty of • at the above and f going information is true and correct and that the ppli t is a resident of Indiana
•and owner/contract buyer of the aforementioned property on date application is filed.
Si ay (owner' ful� 1 na, e) ? t (month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code)
106 N Hull St., Haubstadt, 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,state,and ZIP code)
The penalties for oeriury can include imprisonment uo to two and a half years and a fine not to exceed$10.000.