Loading...
HomeMy WebLinkAboutMortgage_Klem (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 4- FOR DEDUCTION FROM ASSESSED VALUATION t� /// 680, �j State Form 43709(R14/1-20) RECEIVED Gibson 1 /j"'n / • 2021 �� ,e„--�• Prescribed by Department of Local Government Financesof) 1�+/1 1/Vl /'M INSTRUCTIONS: To be filed in person or by mail. ice+"/�T? SCA_,,�,,/ JAN 0 4 2022 File Mark F• filed with: Filing Date: Form must be 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 r. County Auditor 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) TAMMY KLEM Taxing District 0 r Key number/legal description RrZu p��r P e �© . 26-19-19-101-000.388-026 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applican a sole assessment date,current year assessment date,current year date of application legal or equi le owner? 146,000.00 Yes El 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 roperty in question:Annually Assessed I�Real Property ❑ Annually Assessed IL Mobile Home(IC 6-1.1-7) CITIZENS BANK,N.A. ;■�J_��„J/ Name of mortgagee or contract seller (-,_�- ■ Address of mortgagee or contract seller(number and street,city,state.and ZIP code) PO Box 202060,Florence,SC 29502-2060 JAN 0 5 2022 Name of assignee or other owner or holder of mortgage mm 6Ne Address of assignee(number and street.city,state,and ZIP code) o eso Ei6o Y A DI Does applicant own property in a If yes,what county? What Taxing District? Has this deducti n en requested If yes,state amount of deduction other county on property for in Indiana? CI Yes o current year? Yes ❑No A person is not entitled to this deduction unless the person has a balance on the person's mortgage or n act 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 officetha 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 ` �` Da e( o ay.year) I/We certify under the penalty of perjury that t above and foregoing information is true nd correct and that the applica is a esident of Indian and owner/contract buyer of the aforementioned property on date application is filed. i (ow er' f Ina e) Date(month.day,year) December 6,2021 Fu I rest ent address of a cant( m r and street,city,state.and ZIP code) 600 S Lincoln St,Fort Branch,IN 47648-1716 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) December 6,2021 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 STATE - T 9 F OR _ ' 's . • CONTRACT IN TEDNESS Name of applicant N e+f1 .ee`orrysenntrraact sell TAMMY KLEM �C. J Date filed(month,d y, r) !'l Amount of indebte�r N 0 5 2022 Taxing District \('' r may., xJ tV.. 1' 146,000.00 ,, r�/'({( `� (//'� (''�) '= ITI Key number)legal scripti�n 4-y ,l/.:tz.` na) v\ 6 1 '1 2 26-19-19-101-000.388-026 GIBBON COUN�Y 1�UDI�OR om ~`' Signature of County Audit Cou Recorder ) ounty Date(futon .dad-I ,r,�,„z,V.