HomeMy WebLinkAboutMortgage_Chappell w STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.4e ::t` FOR DEDUCTION FROM ASSESSED VALUATION RECEIVED 1
>' v' State Form 43709(RI 1 6-09) Gibson Petuka ' 2020
' , " Prescribed by Department of Local Government Finance DEC O.4 2020
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INSTRUCTIONS: 10 I kk File Mark
To be filed in person or by mail.
Filing Dates: 1.) Real Property: Must be completed and dated in the calendar year for which the deduction is sought. For n filed with:
Must be filed with the County Auditor or County Recorder of the county where the property is located
on or before January 5 of the immediately succeeding calendar year. County Auditor
2.) Mobile/Manufactured Home not assessed as real Property: Must file with the County Auditor of the 0 County Recorder
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer—see restrictions on reverse side)
* James Chappell and L.Michelle Chappell 01.2
Taxing Ds�{(i t 1p Key number/legal description �p .I htecord number Pa e u ber
* V�O * PT MD 24 1 10 9.148 AC �b���`� p — (��`�" OD2�d31�, r?O��O
Assessed value of real property as of Mortgage/Contract indebtedness unpaid Mortgage/Contract indebtedness Is the applicant the sole
March 1,current year as of March 1,current year. unpaid as of date of applicatio , legal or equitable owner?
* $0.00 * $236,360.00 * $0.00..¢g /, l i O .4a) ®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 the property in question: Annually Assessed
0 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Hoosier Hills Credit Union
1 -11--)
Address of mortgagee or contract seller(number and street, city,state,and ZIP code) Q t
* 630 Lincoln Avenue,Bedford, IN 47421
Name of assignee or other owner or holder of mortgage DEC n 2020
Address of assignee(number and street, city,state,and ZIP code) VY .
s _`---
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Does applicant own property in any other In yes,what county? What Taxing Dis is deduction been re uested on property
county in Indiana? GIBSON COU Tat scaiak' e ?
❑ Yes ❑ No Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 0 20 20 20 20
Signature of County Au 't m it()
CC:-%—/D
County 'Son Date Pnor f,
, day,ye 2_ '
I/We certify under the penalty of perjury that the above and foregoing information is trt d correct and that the applicant is a resident ofofInddiana and
owner!contract b yer of the afo ementioned property on date application is filed.
Signatur o <•l full na w r n p/ _C Date(month, day,year)
CJ%¢�tX //-73 020�?o
Full sident ad,r• s of applicant(number and street, city,state,and ZIP code)
5129 N 75 E,Patoka, IN 47666
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)