HomeMy WebLinkAboutMortgage_Plunkett STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSCounty Township Year
�; ;- '.\ FOR DEDUCTION FROM ASSESSED VALUATION t �^ (h 2022
} Y � State Form 43709(R14/1-20) f v" 0 �"
4�;!SP' Prescribed by Department of Local Governme nance File Mark
- 4
INSTRUCTIONS: e � (3� '- ',
To be filled in person or by mail. - %%` Fo m led with:
Filing Dates: Form must be completed and dated in the calenda year for which the deduction is siettifght.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the
property is located on or before January 5 of the calendar year in which the property taxes ae first due County Auditor
and payable. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Kyle W. Plunkett
Taxing Disn Key number/legal description 26-19-19-101-000.410-026/ Record number Page nu er
Assessed value of rea property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant a sole
assessment date,current year assessment date,current year date of application leg I equitable owner?
$107,025.00 Yes 0 No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with who
If name on record is different than that of applicant,indicate below iLLV*41) s Real e property Property in question:❑Annually Annually Assessed
Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank n 1 l 2 1 2.02 '
Address of mortgagee or contract seller(number and street,city,state,a IP code)
711 Main Street, P.O. Box 360, Jasper, IN 47547iaG 'ta)
Name of assignee or other owner or holder of mortgage N"rY ',um-Tog
Gt COU
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this dedu on gen requested If yes,state amount of
other county on property for deduction
in Indiana? 0 Yes 0 No current year? Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c tr t 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) at i the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of Cou Audit - County Date(rmnth,da ,47)7
I/We certify under the penalty of ury that the above and re ing information is true and correct and th at the a plicant is a resident of Indiana
and owner/contract buyer of the aforementioned property on date application is filed.
lure(owner's full name) Date(m th,day,year)
,�� y. (Ai, P,Q,,t,�,,lt,�- I )2 I '7,'Z
F 11 nt add resideress of applicant(number and street,city,state,and ZIP code)
401 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)