HomeMy WebLinkAboutMortgage_Meade .0,,re , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
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a FOR DEDUCTION FROM ASSESSED VALUATION
, r';a State Form 43709(R14/1-20) - Gson 017 2021
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�me 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. 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)
Meade, Clinton C/April D
Taxing District Key number/legal description Record number Page number
017 26-05-12-300-003.024-017 21 rq Z .
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?
156,500 IZYes ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
• r tilt
If name on record is different than that of applicant,indicate below: FF I Lis he� ro question:Annually Assessed
Ji Real Property, ❑AnnuallyAssessed
P Y
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller JAN 1. 41021
German American
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) A ./
Name of assignee or other owner or holder of mortgage GIBBON CO i� ;,OR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deductio b requested If yes,state amount of deduction
other county on property for
in Indiana? III Yes ❑No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c nt ct 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's the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 r 20 20
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Signature of 4
County Date(month,day,year)
3 O� . 1/14/2021
I/We certify under the penalty of peq.. th the :•ove and foregoing information is true nd correct and that the applicant is a resident of Indiana and
owner/ ontract buyer of th of entione• prope on date application is filed.
Signatu ner' ull n e) Date(month,day,year)
X..
1/14/2021
Fu i nt res ap i (number a st et,city,state,and ZIP code)
75 E 590 N, Patoka, IN
Person authorized by duly executed Power f 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)