HomeMy WebLinkAboutMortgage_Scheller .,E,,•4� STATEMENT OF MORT_GAGE_CR C[�IVTrrznc�r__Ikin��zTcnn'=SS
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1. ..,,.� ' State Form 43709(R14/1-20) ,jC l-1 / IT iq Gibson Fort Branch 2020
,01i--a Prescribed by Department of Loci j7Y1 i3(��'Y
/��-� File Mark
INSTRUCTIONS: To be filed in person or by m
%� Form filed with:
Filing Date: Form must be completed and di ,AD ,a190 g 'ght IZ' County Auditor
Must be filed or postmarked wit! . where the property is
located on or before January 5 c ;t due and payable. ❑ County Recorder
See reverse side for additional instructions and q—,,,,,,o,,,,,,..
Applicant(owner or contract buyer-see restrictions on reverse side)
Scott& Kim Scheller
Taxing District Key number/legal description Record number Page number
Fort Branch 26-19-19-102-000.560-026 0O aC). Q®Ei
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?
$ liallTerer0" 130i000 Z Yes ❑No
If no,what is his I 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
i i1 eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller o
Community State Bank ' z
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) FC y
es-
Name of assignee or other owner or holder of mortgage Gip e 4
,„A •
Address of assignee(number and street,city,state,and ZIP code) "/(/N ��'
1,y a.
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Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requ�fe9d If yes,state amount of deduction
other county on property for Op
in Indiana? ❑Yes ®NO current year? ®Yes ❑No
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
Signature of County Auditor County Date(month,day,year)
, , sr._ 417,,) Gibson 12/15/2020
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementi ned prperty on date application is filed.
,. Signatuce(,owner's f ll ame) � Date(month,day,year)
'.'\�(\/ Q la -4 — ,
FL adc7r'ess of ap licant umber and street,city,state,and ZIP code)
805 E Strain St., Ft. 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 periury can include imprisonment uo to two and a half years and a fine not to exceed$10.000.