HomeMy WebLinkAboutMortgage_Forshee STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
. , State Form 43709(R14/1-20) Gibson Johnson 2022
4--", Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. RI County Auditor
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 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)
Michael W&Jennifer K. Forshee
Taxing District Key number/legal description Record number Pa�/rur
Johnson 26-23-13-400-000.039-024 2022 l l(
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?
$ 80,000 Yes ❑No
If no,what is his I 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: I Is the property in question:Annually Assessed
10 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgaoee or contract seller
ONB
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) FILED
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) MAR 21 c022
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been r ted If yes,�.s7ta�te ra�unt of eduction
other county on rroperty for CG y/
in Indiana? El Yes �No current year? Yes �ydy,42J
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness-th`af IsYrec Od7 IAe 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"'ounty Auditor / County Daten,+`� ea ^ ��
iiiAV/ ...11frrr"r»lvvv/// Gibson (///��
I/W certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant i-a resident f Indiana and
owner/contract buyer of the aforementtt'pned property on ate application is filed.
Signature(own s fu n ) • // /Z n Date 7n7a.year)
Fullresiident address of applicant(nuumberr and street,city,state,a ZIP code) �
5212 E 1300 S, 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,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
Name of applicant Name of mortgagee or contract seller
Michael &Jennifer Forshee ONB
Date filed(month,day,year) Amount of indebtedness Taxing DistrictF liT4 ED
3- 2 Z - r�2`Z - $80,000 Johnson
Key number/legal description c��
26-23-13-400-000.039-024 �� C.C-- "1 Mk 21 2022
Signs 1111 f County Auditor/County corder /s! / County Date(month,day,year) i/rMI-�UI'��Y(_�rO`J,[J'r1J/(A ir/yty/ Gibson
a.
G1BSOM COUNTY.AUDITOR