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HomeMy WebLinkAboutMortgage_Deal (8) .M4"4*eq, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year ‘'..-=% A FOR DEDUCTION FROM ASSESSED VALUATION °'\ J. 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 file 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 located on or before January 5 of the calendar year in which the property taxes are first due and payable. 0 County Recorder See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Ryan Deal and Sarah Deal Taxing District Key number/legal description Record number Page number 024 26-23-14-400-000.926-024/S S SE 14 4 10 2.50 Ac D-9, Gibson County "j C 0QOO '(A C) 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 datg of application legal or equitable owner? f 1f 2, ^ ��_ a Yes ❑No If no,what is his/her exact share of interest? If owned with someon4 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 -- yi tiM roperty 0 Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller FIL , .. -. Fifth Third Bank Address of mortgagee or contract seller(number and street,city,state,and ZIP code) FEB 25 2021 5001 Kingsley Drive, MD: 1MOBA8 Cincinnati, OH 45227 Name of assignee or other owner or holder of mortgage // Address of assignee(number and street,city,state,and ZIP code) GIBSON t;UUihiT't AUDITOR Does applicant own property in any If yes,what county? What Taxing District? Has this deduction be requested If yes,state amount of deduction other county on property for in Indiana? ❑Yes iRt 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 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 � County\ Date(month,day,year) I/We certify under the pena of perjury that the above and foregoing information teotrue and correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. `,Sjgnature(owne s full name)_ - —-Date(month,day,year) — - 4.....tett Full resident addrfiss of applicant(number and street,city,state,and ZIP code) 4591 East 1300 South, Evansville, IN 47710 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 oeriury can include imprisonment up to two and a half years and a fine not to exceed$10,000.