HomeMy WebLinkAboutMortgage_Watkins (2) .0En„e STATEMENT OF MORTGAGE OR CONTRACT-INDEBTEDNESS '
., %'. FOR DEDUC County Township Year
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~' I'.::rt1� State Form43709(F Gibson Washington 2021
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Drawer NO a6 File Mark
INSTRUCTIONS: To be filed it Form filed with:
Filing Date: Form must be c is sought. 171 County Auditor
Must be filed or Card NO. �� ;ounty where the property is ❑ CountyRecorder
located on or bt 3re first due and payable.
See reverse side for additional it
Applicant(owner or contract buyer-see restrictions on reverse side)
David R. & Kimberly Watkins
Taxing District Key number/legal description Record number Page number
Washington 26-06-20-400-003.786-017 coo D.,O ( . --I
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?
$ 360000 jYes ❑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 pr in question:Annually Assessed
®Rea p y' -A nuallyAssessed
M e(IC 6-1.1-7)
Name of mortgagee or contract seller ggg
SteaWkS—Lealin
0 149Address of mortgagee or contract seller(number and street,city,state,and ZIP cAN 2 5
2421
Name of assignee or other owner or holder of mortgage .
Address of assignee(number and street,city,state,and ZIP code) G'feS.ON C�UQ
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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 current year?
❑ ®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 20
Signature of County Auditor County Date(month,day,year)
�� Q Q Gibson 01/25/2021
I/W..,certify under the penalty of perjury that the above and fore oin formation is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property date application is filed.
Sig tur (owner's full ) Date(month,day,year)
'c n /c2i2 01/25/2021
Full resident address of applicant(number and street,city,s e,and ZIP code)
7042 E 350 N, Patoka, IN 47666
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.