Mortgage_Wilson (2) r + •
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-0•°;, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r FOR DEDUCTION FROM ASSESSED VALUATION
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.' • Slate Form 43709(R14/1-20) Gibson Ft. Branch 2020
,e m , Prescribed by Department of Local Government Finance k
File Mark
INSTRUCTIONS: To be Bled 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 am first due and payable. 0 County Recorder
See reverse side for additional instructions and qualifications. •
Applicant(owner or contract buyer-see restrictions on reverse side)
Chris Wilson &Jill Muensterman
Taxing District Key number/legal description Record number Page number
Ft. Branch 26-18-13-402-000-282-026 2020 706
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?
$ 114,000 ®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
" 'A Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller --"4lb
Quicken Loans OFF,
Address of mortgagee or contract seller(number and street,city,state,and ZiP code) zi6
Name of assignee or other owner or holder of mortgage OfiesO- ' el/J'B
Address of assignee(number and street,city,state,and ZIP code) �ry "��
Does applicant own property in any if yes,whet county? What Taxing District? Has this deduction beeny frOzsted If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ®No current year? 1Zr/es LLLJJJ 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
Sig ture of County Auditor County Date(month,day,year)
,,.},N__ e). Gibson 1, -QR -a O
II We certify under the penalty of perjury that he above Ort,foregoing information Is true and correct and that the applicant is a resident of Indiana and
owner i contract buyer of the aforementioned date application is filed.
Signature_ (owner's full name) Date(month,day,year)
Full`resident address of applicant(number and street,city,state,and ZIP code)
400 N. Main St., F. 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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Chris Wilson & JIII Muensterman Quicken Loans
Date filed(month,day,year) Amount of Indebtedness Taxing District
1'a -.De?-(0PC) $114,000 Ft. Branch
Key number i legal description
26-18-13-402-000.282-026
Sign-ture of County Auditor i Coun RecorderR -_ County Date(month,day,year)
Li._SLR m) Gibson 1 a—a$ p
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