HomeMy WebLinkAboutMortgage_Geuss � Dz.% STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a FOR DEDUCTION FROM ASSESSED VALUATION
ft _._. ^ �is
31._ , State Form 43709(R14/1-20) Gibson Johnson 2020
. --✓' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
WI 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)
Darrell Geuss
Taxing District Key number/legal description Record number Pa e number
Johnson 26-23-05-300-000.797-024 to O a COS/
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?
$ 109,000 I21 Yes ❑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 0 0 O-0 _ J g /(O (? Is the property in question:Annually Assessed
Q i fr1 R, al Property ❑Annually Assessed
4 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller D ra`ve r 1\TO
Elberfeld State Bank 40-.
,
e s of or co tract seller
Addr s n ( D�C
Card NO. (, 3®�020
Name of assignee or other owner or hole
Q/e �',,
Address of assignee(number and street,city,state,and ZIP code) -ON [B
Does applicant own roe anyIfyes,what county? What TaxingDistrict? Has this deduction been)eques e811t.� s,state amount of deduction
PP property rtY in tYq (���
other county Yes No on property for Yes No op
in Indiana? ❑ ® current year? ® ❑
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) ,
� ,,til,t Gibson 12/30/2020
I/We certify under the penalty of perjury that th above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforeme ioned roperty on date application is filed.
Signatur= . •is full na Date(month,day,year)
/ /16e, 12/30/2020
'n. - dent address applicant( mber and street,city,state,and ZIP code)
696 E SR 68, Haub adt, IN 47639
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 u. to ..o-,. . .- and a fine not to exceed$10,000.