HomeMy WebLinkAboutMortgage_Elaman , R,*• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
11 FOR DEDUCTION FROM ASSESSED VALUATION
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t-... �• State Form 43709(R14!1-20) �,�E/1TPD Gibson
> ,a.e" Prescribed by Department of Local Government Finance
(64
INSTRUCTIONS: To be filed in person or by mail. ( J* [&4.
'1 DEC 2'12020 File Frled with:
Filing Date: Form must be completed and dated in the cadar year f r which a deduction is sought. m 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 on reverse side)
Bradley S. Elaman TEL-
0O2„5 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?
$124 ,000 .00 lid Yes El 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
®Real Property ❑AnnuallyAssessed
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank F IT 4. -t-4 1-4)
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
711 Main St. , Jasper, IN 47546 DEC MU
of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) t-t7__
e; T
Does applicant own property in any If yes,what county? What Taxing District? GIOSMOdaer`i etiYegbelstedl I COW,state amount of deduction
other county on property for
in Indiana? Dyes ®No current year? 1i1 Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or••nt=ct 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 0 20 20 20 20 20
Signature of County Audi r �' ,_ i ^^/ County '�O Date(month, ay,yea �_n ir\AA � f�1 Jl� Y) t r il' 2 1 �'-J
I/We certify u der the penalty of perjury t above and foregoing information is true nd correct and that the applicant is a siden of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature if ame)�� Date(month,day year)
r.'�_ /2_ /1p /202Ci
Full resident address off licant(number and street,city,state,and ZIP code)
1877 S Collins; Francisco, IN 47649
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 110 to two and a half vearc and a fins nnf fn avraari a1n nnn