HomeMy WebLinkAboutMortgage_Green (3) '°' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tFOR DEDUCTION FROM ASSESSED VALUATION
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` .g State Form 43709(R11 6-09) Gibson Oakland City 2021
�V,— Prescribed by Department of Local Government Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail.
Filing Dates: 1.) Real Property: Must be completed and dated in the calendar year for which the deduction is sought. Fo m filed with:
Must be filed with the County Auditor or County Recorder of the county where the property is located t+pti County Auditor
on or before January 5 of the immediately succeeding calendar year. 'ry�J�
2.) Mobile/Manufactured Home not assessed as real Property: Must file with the County Auditor of the County Recorder
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.
Applicant(owner or contract buyer-see restrictions on reverse side)
* Coy W.Green and Tricia B.Green
Taxing Distr Key number/legal description Scuff NLG `.1 5 .I 'd(.-14"t$ 3G Record number Page number
Dist SOUTH ENLG 7/8 BLK 2��y 14-ii'--3t -OM, ("C.CCol''3ctS-t6 7 2-0 Z 8 t
Assessed value of real property as of Mortgage/Contract indebtedness unpaid Mortgage/Contract indebtedness Is the applicant the sole
March 1,current year as of March 1,current year. unpaid as of date of application legal or equitable owner?
* $0.00 *$0.00 *$66,600.00 D Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
FILIF:fi"tihRe If name on record is different than that of applicant,indicate below: pro perry in question: AnnuallyAdAssessed
eal Property ❑ Annually
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller DEC 0
* German American Bank 2021
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
* P.O.Box 360,Jasper, IN 47547-0360 ,
Name of assignee or other owner or holder of mortgage 471shee..iuzzi . ' 1 f" .'`"'"**'
GIBSON COUNTY AUDITOR
Address of assignee(number and street, city,state,and ZIP code)
Does applicant own property in any other In yes,what county? What Taxing District? Has this deduction been sted on pro erty
county in Indiana? for current year?
❑ Yes No Yes No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20� e i0 20 r0 20 20
Signature of County Auditor ie � y��A,�A County r `O Date il the Ataa l
I/We certify under the penalty of perjury that the above and foregoing information is trued correct and that the applicant is re dent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature wner's fu l nam . �: _ / Date(month,day,year)
-t.�� � -,4\ 11/16/2021
Full resid address of applicant(number and atreet, city,state,and ZIP code)
* 131 Oak St.,Oakland City, IN 47660
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)