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HomeMy WebLinkAboutMortgage_Curry (3) STATEMENT OF _ -`-- "-SS County Township Year :�;,1,ii FOR DEDUCTIO Gibson Princeton 2021 State Form 43709(R14/1 -,^,-..�,[ ---- Prescribed by Departmt Drawer N O.... . ✓0„.„... I File Mark INSTRUCTIONS: To be filed in pers (� Form filed with: Card NO. C� 1 aught. © County Auditor Filing Date: Form must be comply aught. where the property is Must be filed or postr 0 County Recorder located on or before ,d,rn ,y L."atm.�.•a••�u•, , . ••• ,, rst due and payable. Applicant(owner or contract buyer-see restrictions on reverse side) Marc Curry&Taylor Waddell Taxing District Key number/legal description Record numberI Page number Princeton 26-18-36-300-002.796-024 ----tt ti Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of date f MortgageI ntrct indebtedness unpai as of Is legalthe or applicant ll�nt the sole assessment date,current year assessment date,current year $451,000 RI Yes ❑No 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 ❑Annually Assessed PI 4-kvij Mobile Home(IC 6-1.1-7) Nam s of mortgagee or contract sellernFirst Federal Saving Bank Address of mortgagee or contract seller(number and street,city,state,and ZIP code) pet 9 Name of assignee or other owner or holder of mortgage [; ` t%eo J Address of assignee(number and street,city,state,and ZIP code) B`g0� ,"'� " Ali Does applicant own property in any If yes,what county? What Taxing District? Has this ddeedue en requested If yes,state amount of deduction other county current year? it Yes ❑No in Indiana? El Yes ©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 (...eSignet =of Coun Auditor County Date(month,day,year) t \ ^\ �„L A�� Gibson 12/20/2021 I/We certi.+under the penalty of perjuryy that�the above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner I contract buyer of the aforementioned property on date application is filed. Signature(owner's full name) Date(month,day,year) Q 1. •\M o 12/20/2021 Full resident address of applicant(number and street,city,state,and ZIP co a) 1335 W 1000 S, Haubstadt, IN 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.