HomeMy WebLinkAboutMortgage_Johanningsmeier o�J,,,n; „. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4; . ,a FOR DEDUCTION FROM ASSESSED VALUATION
.A. 1\ ,,, State Form 43709(R14/1-20) G'son 009 2021
" met-" •% Prescribed by Department of Local Government Finance
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. RI County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly 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)
Johanningsmeier, Grant/Kaley
Taxing District Key number!legal description Record number Par^%.„-=r
009 26-18-36-401-000.650-009 2020 Sji —
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?
2O2)000 EYes ❑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 Pro erty Annuall Assessed
Name of mortgagee or contract seller �IP
(�uni (A) ICaa�c o,- Q, FI
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) v J
JAN ail 2oxr4
Name of assignee or other owner or holder of mortgage r�
lvJ
Address of assignee(number and street,city9
,stale,and ZIP code)
GIBSON COUNT t —i151.R
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No currentyea0 ®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
Signature of County Aju:
f 1 County Date( onth,day,year)
C _ U:IL Gson C 2021 .
1/We certify under the penalty of perjury that th e and foregoing information is true and correct and that the appli t is resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Signatur ( wner's f 1 ame) . Date(month,day,year)
`�(Jy;� /-d -.1oal
Full resident addre s of applic t(number and street,city,stale, d FfP code)
1002 Adam Ct, Haub, 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 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 I Name of mortgagee or contract seller M
Johanningsmeier, Grant/Kaley i }- - ota-sO- . y ( le—.
Date filed(month,day,year) Amount of indebtedness ` ,- -1 axmy u strict
1.6- `koz 1 $ :.,, ; - __ k
009
Key number I legal description „v-�
26-18-36-401-000.650-009 JAN 06. 2021 �f-0 .5 b 5 14
Signature of C unty Auditor!(County R order - County \ Date(month,da,year)
A
GIBSON COUNi`r ,•:.__.10"