HomeMy WebLinkAboutMortgage_Cross (2) �•.R•4z., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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4, 'i FOR DEDUCTION FROM ASSESSED VALUATION Gson 018 2022
State Form 43709(R14/1-20)
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,e1„ ✓', 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. WI County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is CI County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Cross, Kyle B/Emily M
Taxing District Key number/legal description Recordnum Page n bpi
018 26-02-58-001-003.193-018 - (w
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?
290,000 VIYes ❑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 property in question:Annually Assessed
l Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Pit
German American _ i)
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) SFP
Name of assignee or other owner or holder of mortgage 'I 1�22
CO4
Address of assignee(number and street,city,state,and ZIP code) G/ sa l
�°NT) v,
Does applicant own property in any If yes,what county? What Taxing District? Has this deducticvquested If yes,state amount of deduction
other county on property for T
in Indiana? El Yes ❑No current year? VlYe6' ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract 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 rAuaxtmclJ County k Date(mo h,day, ear)
ji_s
I/We certify under the penalty of perjury that the abo nd foregoing information is tr e nd correct and that the applicant i a resi ent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sign,ure ow s.full name) Date(month,day,year)
9 C--_,--4..
Full resident ddress of a t tuber and street,city,state,and ZIP code)
218 E 0 N, Hazelton, IN 47640
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 ONTRACT INDEBTEDNESS
Name of applicant Name of mo Lact seller
Cross, Kyle B/Emily M Germ A nr
Date filed(month,day,year) Amount of indebtedness ax ng isftri
G^-Zt_�ZZ 290,00o SEP Z 0
Key number/legal description 12022 ,,( 7 2_,_ z 4 G g ,
26-02-58-001-003.193-018 v mot, t
Signature of County Auditor/County Recorder ,^^\_fl Coun D (month day,year)
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