HomeMy WebLinkAboutMortgage_Kolb (10) ,,-; ..,,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-.. FOR DEDUCTION FROM ASSESSED VALUATION
"'\ 1 ;`.�,`?� State Form 43709(R14/1-20) Gibson Washington 2020
`'`"�%1' Prescribed by Department of Local Government Finance
�616
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. 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
Record number Page number
Washington 26-06-07-102-000.882-017 2L 6 jluQ
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?
4 )27wo DYes ❑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,indicat holnw_ Is the property in question:Annually Assessed
I'e0 Real Property ❑Annually Assessed
' l ome(IC 6-1.1-7)
Name mortgagee or contract ley-
Address ,'.f mortgagee contract seller(number an sta
app_A
Drawer NO C)D_6 vitd
yp
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Name of assignee or other owner or holder of mortgage Card NO, ®
D l•
•
•
•
Address of assignee(number and street,city,state,and ' AuD`I.OR
e4 Ql1NTY
Does applicant own p erty in any If yes what cou ty? What Taxing District? Has this deduction been re J 1 If yes,state amount of deduction
other county 7 on property for
in Indiana? Yes ❑No a'b c / (tJ( current year? ❑Yes ❑No MAYB F i -1z f
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
Signat f%ounty Auditor 'County b91/1--
Date(month day,y9ar)
(611/4. ...e
We certifyunder the penaltyof perjury th e above and foregoing information is true and correct and that the applicant is a res dent of Indiana and
P J rY9 9 PP
owner/contract buyer of the aforementione roperty on date application is filed.
Signs - owner's full ame) Date(month,day,year)
►11 12/10/2020
Full r- (J-nt address-7 applicant(num er and street,city,state,and ZIP code)
. , .._. a .a-_.._.r......tab... == 6167 N 600 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)
The penalties for periury can include imprisonment up to two and a half years and a fine not to exceed$10,000.