HomeMy WebLinkAboutMortgage_Dillon (4) ,0 F-T.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
..Ni FOR DEDUCTION FROM ASSESSED VALUATION
g.,.'..tV State Form 43709(R14/1-20) Gibson Owensville 2020
. '" . Prescribed by Department of Local Government Finance
rein
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. IZI 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)
Jack &Amanda Dillion
Taxing District Key number/legal description Record number Page number
Owensville 26-17-01-404-000-506-022 4t9s-
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I 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?
$ 40,000 ®Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other tha spouse,indicate with whom
If name on record is different than that of applicant,indicate below: s t -'pr,''arty in question:Annually Assessed
;r� ' d Prop ❑Annually Assessed
obile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 12
Owensville Church of the Nazarene C fi �*`a
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �' 1
0S G/e 4 �0
Name of assignee or other owner or holder of mortgage SUM COS
Gnr)L
Address of assignee(number and street,city,state,and ZIP code xi(/
Does applicant own property in any If yes,what co, %,? . t Ta ' g District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Ill Yes ❑No ^ current year? ®Yes ❑No
A person is not entitled to this de• ction u - ' e re erson has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any ho'; eq'.t'i •-'r f 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)
ALasJ,_ L•,_4171 ,) Gibson 12/31/2020
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signatur ( wnerrs�t� me) Date(month,day,year)
yt�//,�YJr 12/31/2020
Fu I resident ress of applicant mber and street,city,state,and ZIP code)
201 E st oplar St., Owensville, IN 47665
Person aut oriz 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)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.• •-• -