HomeMy WebLinkAboutMortgage_Siebert 4/•^ie,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
` _.',t\ FOR DEDUCTION FROM ASSESSED VALUATION
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�'-J`.., :,'�.'1 State Form 43709(R13/10-15) p E.1VLD co• unty
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•�e b�� Prescribed by Department of Local Government Finance
INSTRUCTIONS: I� T FEB 18 ZU11 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Musrbe completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Aoolicant(owner or contract buyer-see restrictions on reverse side) -
Siebert,Mark A and Abigail J
Taxing District Key number/legal description Record number Page number
Ft Branch 26-19-19-103-000.007-026/LOWES ADD 3 2to 21 C
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?
102600.00 11510.00 111.500.00 x 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_` _
xReal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ILED
First Savings Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) i
PC)Box 22527.Lnui.sville.KY 40252
Name of assignee or other owner or holder of mortgage FEB Il.8;2021
Address of assignee(number and street,city,state,and ZIP code) Am.,/C.G.14'7.4
GIBSON COUNTY AUDITOR
Does applicant own prope ' any If yes,what county? What Taxing District? Has this deductio b•an requested If yes,state amount of deduction
other countyproperty for
in Indiana?
El Yes No current year? E(Yes ❑No
A person is not entitled to t is deduction unless the person has a balance on the person's mortgage or,on -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 is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
•
20 20 20 20 20 20 20
Signature of County Audito r J . County \ Date moot ryy,xear)
I/We certify under the penalty of perjury that the above and foregoing information is rt a and correct and that the applicant is a resident of Indiana and
-_ owner Lcontrackbuyer_of-the-aforementionedproperty-on-date-application-is-filed. — - ---
ig tur ( neYs full Warn ) n
�.�fe� . 7 -F�, • Datemonthd ay year)
Full resident ad ess of b�olicant(number and street.city.state.and ZIP code) �/(l( Gn( ^( 1
904 S Center St.Fort Branch.IN 47648
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
Nam�'of applicant) (�, . - : .eeorconter %oil k .
Ci
Date filed(month,da.year Amount of i eFJlNa
e • ,-. 1- xing Distri 7
2'1Y• o21 11 -°Us'-' �� rr
Key number/le Ides ion PrC� �'.p��021 (2/.02\ -9-E,2, .1=-1 .-,=1 i
Signature of County Auditor 1 Count ecor /'� nJ/Y2`''-� -A Date(month,day,.�`f air `
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� �yk^'` GIBBON CUNTY AU ' Q .- 1 D - y
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