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Home My WebLink AboutMortgage_Kielb 454:`t"fa� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year i, _~ 't. FOR DEDUCTION FROM ASSESSED VALUATION \Sp✓� I Q 2 G I j2 Z �t 3 �� State Form 43709(R14/1-20) J File Mark '�.....,.,_,--'r' Prescribed by Department of Local Government Finance INSTRUCTIONS: To be filled in person or by mail. Form filed with: Filing Dates: 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 County Auditor property is located on or before January 5 of the calendar year in which the property taxes ae first due 0 County Recorder and payable. See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Megan Kielb Taxing District Key number/legal description 26-19-18-301-000.634-026/ Record number Page number ©�� e _ /U . C.hurc h `J-t. F-. &'rz,rtcit, /At% �&iig o�O?. ( q rc Assessed value of real property as of Mortgage/Contract Indebtedness jnpaid 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 squitable owner? $127,073.00 es 0 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 operty in question: Annually Assessed eal Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Guaranteed Rate Inc. 4 04, 'le:e/6's..>40....‘ Address of mortgagee or contract seller(number and street,city,state,and ZIP code) CAA 3940 N Ravenswood Ave, Chicago, IL 60613 s' 21 Name of assignee or other owner or holder of mortgage C'OG� <�� Address of assignee(number and street,city,state,and ZIP code) r{'�� G Does applicant own property in any If yes,what county? What Taxing District? Has this d been requested If yes,state amount of other county on property f deduction in Indiana? ❑ Yes No current year? C Yes 0 No A person is not entitled to this deduction unless the person has a balance on the person's mortgage or conra\8t 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)that 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 Date(month,day,year) `t‘(\v �CCe-ct- t_Q --tJ 03 • `i k c t -) . 1--1 -a1-Zo ZZ I/We certify under the penalty of perjury t at the above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner/contract buyer of the of��tioned property on date application is filed. D.,,_(,„„ th,da�year) Sig lure(owner's full name) `ri,f 2 5 22 Full resident ad, ess of applicant(number and street,city,state,and ZIP code) 206 N Chu 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) The penalties for perjury can include imprisonment uo to twn and a half years and a fine not to exceed$10,000.