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HomeMy WebLinkAboutMortgage_Guisewite -0".",�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship • Year oq%;4s -k ,i. `i = FOR DEDUCTION FROM ASSESSED VALUATION ^� �' K, '' � State Form 43709(R14/1-20) Gibson 0 -6 2020 ti� �., RECEIVED �a�s Prescribed by Department of Local Government Finance e File Mark INSTRUCTIONS: To be filed in person or by mail. (60$Se I DEC 0 8 2020 Formr filed with: Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. Lr I 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. 0 County Recorder See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Amanda M. Guisewite Taxing District Key number/legal description Record number Page number ©� 26-19-18-303-000.891-026/Walters Add 122 Pt/123 Pt rfj00-40 SSE 4 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 ee owner? $135,000.00 �i Yes 0 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 th operty in question:Annually Assessed Real Property ❑ Annually Assessed i, Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller German American Bank F f ".IL Li ,� Address of mortgagee or contract seller(number and street,city,state,and ZIP code) • PO Box 360,Jasper, IN 47547-0360 DEC 0 ZOZO Name of assignee or other owner or holder of mortgage I.Fi�— Address of assignee(number and street,city,state,and ZIP code) _ � ,4� 9 Y srf'�' �n COUNTY AUDil°R Does applicant own property in y If yes,what county? What Taxing District? 61 sthis deducti b en requested ' If yes,state amount of deduction other county El Yes No on property for Yes El No in Indiana? current year? A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c ntr t 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 Auditor C Y1 � County Gibson Date moot ay, ear) 1rlo. I,We certify under penalty of erjury that t e above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner/contract buyer of the a rementi ne property on date application is filed. Sigofature(owner's ull nay? ate(month,day,year) Full�re 'dent address of applicant(number..arrid street,city,state,and ZIP code) 401 E. Locust St., Fort 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 penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.