HomeMy WebLinkAboutMortgage_Seals *`�•'�a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
fi �*: FOR DEDUCTION FROM ASSESSED VALUATION
ii x • ' .''hi; State Form 43709(R14/1-20) Gibson Haubstadt 2020
a&- e' Prescribed by Department of Local Government Finance
sate
File Mark
INSTRUCTIONS: To be filed 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. 0 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)
Seals, Paul G
Taxing District Key number/legal description R ord number Pan umber
Haubstadt 26-19-31-304-000.370-009 21 8 _
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?
$90,000 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 applicant,indicate below: Is the property in question:Annually Assessed
®Real Property ❑Annually Assessed
Mobile Ham--(IC 6-1.1-7)
Name of mortgagee or contract seller
Elberfeld State Bank lVII
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Y -.18,8').
Name of assignee or other owner or holder of mortgage
Vt
-C.'
Address of assignee(number and stree city,state,and ZIP code) \-(C'
-c P'
Does applicant own property in y If yes,what county? What Taxing District? Has this deduction been requested If yes,state 4,94\deiticlion
other county on property for C
in Indiana? ❑Yes No current year? ill Yes ❑No �C�
A person is not entitled to this deduction unless the person has a balance on the persons mortgage or contract indebtedness that's 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
Signet f Coupty Auditor �J County Date(month,day,year)
,��//(/�- [r�6L/ Gibson 12/22/2020
I/We ertify under the pe Ity of erjury that the abo e and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner contract buyer of the ementioned prope on date application is filed.
Sign lure( wner's full na e) Date(month,day,year)
11 4„,..a....y12/22/2020
Full resident address of applicant(number and street,city,state,and ZIP code)
506 E. Haub Street, Haubstadt, 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 nenaltiec fnr neriury ran include imnrisnnment un In two and a half veers and a fine not to exceed S10.000.