HomeMy WebLinkAboutMortgage_Siekman (6) ,...r,,.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
^ FOR DEDUCTION FROM ASSESSED VALUATION GIBSON OAKLAND CITY �ZZ
State Form 43709(R14/1-20)
's r Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Fo
rm filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 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)
SIEKMAN, KATLYN ROSEMARIE Re�orj)numberQJT Page number
Taxing District Key number/legal description �//��(/�� Je�f(l
OAKLAND CITY 26-14-19-101-000.746-007
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of date f Mortgage/ n indebtedness unpaid as of Is legal applicant
equitable the
sole
er?
assessment date,current year assessment date,current yearYeS ❑NO
$20,000
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
Is the property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: ®Real Property D Annually Assessed
FILED Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
LNB COMMUNITY BANK
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 2022
DEC 1 5
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) /z.G/tZ[G1 & "'•Q
GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? I What Taxing District? I Has this deducti b en requested I If yes,state amount of deduction
other county on property for Yes ❑No
in Indiana? ❑Yes ®No
current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or nt ct 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. the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
I12a 12D 120 20 120
20 20 r
I County I Date_on�,}da.-ydi r) 2.�
Signature fat�O n ud' r \_ r C� \ ��f� L CJ JVwI
I/We certify under the penalty of perjury that the above and foregoing information is a and correct and that the applicant is resi nt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. I Date(month,day,year)
signature w er's full na e) 12/2/2022
Full resident ddress of applicant(number and street,city,state,and ZIP code)
1010 N MAIN ST, WINSLOW, IN 47598 I Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Address of authorized person (number and street,city,state,and ZIP code)
- '--,..ate•,,.nricnnment uo to two and a half years and a fine not to exceed$10,000.