HomeMy WebLinkAboutMortgage_Foil ,.. ....,, ,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County TitrS,hip Year
., ." FOR DEDUCTION FROM ASSESSED VALUATION e , 1---1-\
State Form 43709(R14/1-20) Gibson iflaiolter----- 2021
.`.'7-4-4? Prescribed by Department of Local Government Finance
, ,--- NOV :- ! 7C.17.1 File Mark
INSTRUCTIONS:To be filed in person or by mail. Lt,,..,,r4,,,„_ i
Form ed with:
Filing Date: 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 property County Auditor
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. El County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Mark B.Foil
Taxing District Key number/legal description Record number Page number
028 26-11-13-204-000.539-028/Mckaw Sum 5 Pt/6,Gibson County 2'b2-I otbD()2,)4
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?
116,844.00 al Yes 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 property in question:Annually Assessed
NI Real Property [1] Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Equity Prime Mortgage,LLC DEC 0 1 202.1
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
P.O.Box 1194,Springfield,OH 45501-1194 V-)2,,-i ,j a, .14-4Y464724,)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) GIBSOCOUNTY AUDI-TOR
Does applicant own property i any If yes,what county? What Taxing District? Has this deducti en requested If yes,state amount of deduction
other county on property for
in Indiana? CI Yes No current year? Yes Ell No
A person is not entitled th s 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's the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of cmtrinrcAtA.44.v.s_ County Date( onth, y,year)
II We certify under the penalty of perjury that the above and foregoing information is ru and correct and that the applicant is a r ident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
November 19, 2021
Full resident address of applicant(number and street,city,state,and ZIP code)
610 W McCarty Road Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
November 19, 2021
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.