HomeMy WebLinkAboutMortgage_Brown (16) ,-<"--_•-71-ti--tf-k.s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' : \li) FOR DEDUCTION FROM ASSESSED VALUATION
:i4 - Stale Form 43709(R14/1-20) Gibson 0(?:-) (20 21
k- -"tiV Prescribed by Department of Local Government Finance
Gis xj File Mark
INSTRUCTIONS: To be filed in person or by mail. 7a.iti
Form filed with:
Filing Date: Form must be completed and dated in the calenda year for hi the deduction is sought ' ',I 1 RI County Auditor
Must be filed or postmarked with the County Auditor or County ecorder 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. C] County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jeremy R. Brown
Taxing District Key number/legal description Rg cx.):frolumber Page number,
Haubstadt 26-18-36-400-000.862-009 2-1 2q-- .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app ant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$240,000.00 [0 Yes CD 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: FILE IhReeparolpperrtoypiendqyuestionA:nAnnunuaaillylyAAssss Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Heritage Federal Credit Union ,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) DEC 0 2 2021
5388 Old State Rd 66, Newburgh, IN 47630
Name of assignee or other owner or holder of mortgage VhA,...e a.
c1B.,0N COUNT' AUDITOR
Address of assignee(number and street,city,state.and ZIP code)
Niies applicant own property in any I If yes.what county? What Taxing District? Has this deducti•V-n requested If yes,state amount of deduction
other county ,---, on property for „,.%
in Indiana? LJ Yes la No current year? WA Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or••n. -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 fit- 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 r .,(,.Ls ov..,,, DI 71,•71:15,..°
foregoing information is t e and correct and that the applicant i
I I We certify under the penalty of perjury that the above Q s a resi nt of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Signatu (owner's full name) Date(month,day year)
11/23/2021
Full resident address of applicant(number and street,city,state,and ZIP code)
904 W Elm St., Haubstadt, IN 47639
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,slate.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
Name of applicant Jeremy R. Brown Name of mortgagee or contract seller
atiriFvf,n1 i t n Union Date filed( t
monthA ay. er, Amount of indebtedness =
1 4.•''' q/0 2-1 $24 0 aubstadt
E.
Key number/legal des riptio /2--\ - 6 2_4 __..
26-18-36-400-000.862-009 DFC 0 g 2021 ,......----
Signature of County Auditor/County Rnier County Date G'son (rt\o2lizatzr.0
. 2.1 ,--...
.
GIBSON COUNTY AUDITOR