HomeMy WebLinkAboutMortgage_Coomer (5) r, a- STATEMENT OF.MORTGAGE OR CONTRACT INDEBTEDNESS J_, County Township • Year
( It FOR DEDUCTION FROM ASSESSED VALUATION
_. ' State Form 43709(R14/1-20) Gibson atoka 2020% 1e .4? Prescribed by Department of Local Government Finance RECEIVED
1
DEC 1 0 2010 File Mark
INSTRUCTIONS: Form filed with:
To be filed in person or by mail.
Filing Dates:1)Real Property:Must be comp) ed 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 County Recorder
property is located on or before January 5 of the immediately succeeding calendar year-
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
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)
Cara Coomer,
Taxing District Key number/legal description Record number P�ggpy,ber
Patoka U D • 26-12-16-101-000.927-027 2C) b V-X
Assessed value of real propery s of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpai as of Is the applicant the sole
assessment date,current year assessment date,current year date of application le I or equitable owner?
$112,800.00 128,939.00 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with w m
If name on record is different than that of applicant,indicate below: - Is e pro•erty in question:Annually Assessed
Real P°iterty 0 Annually Assessed
. j ; i : Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
�'_...- _,.=:r �_ r
German American Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) DEC 1 4 2020
711 Main Street, PO Box 360, Jasper, IN 47546
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) CIQSOP! COUNTY AUDITOR
Does applicant own property in If yes,what county? What Taxing District? Has this deduction b n requested If yes,state amount of deduction
other county on property for _ - - •
in Indiana? ❑Yes No current year? Yes ❑No
A person is not entitled t this deduction unless the person has a balance on the person's mortgage or ontract indebtedness that is recorded in the county
recorder's office(includ g any home equity line of credit that is recorded in the county recorder's offs )that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
. 20 , 20 20 20 20 20
Signature of County Auditor .. County Date month,day,year)
A
•
I/We certify under the pena ty of perjury that then For oing information iv ).(-)
nd correct and that the applicant is a resident of Indiana and
ow r/contract buyer of the aforementioned prope application is filed.
Sig ture( ner's full n m Date(month,day,year)
11/24/20
Full re • address of appli umber and street,city,state,and ZIP code)
2068 E. State Ro 4, Princeton, IN, 47670
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 twr,and^-half unarc and a fin=nor#,,o,,,.oaa can nnn ^^