HomeMy WebLinkAboutMortgage_Dunn (11) - t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�"3 FOR DEDUCTION FROM ASSESSED VALUATION
F.- State Form 43709(R14/1-20) Gibson Patoka Township 2021
�_:_ 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. ® 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)
-( 7/3 I �"
Taxing District Key number/legal description Record number Page number
Patoka Township 26-11-13-300-000.129-027
Assessed value of real properly as of Moogage/Contract ra indebtedness unpaid as of Mortgage/Contract indebtedness un as of la the applicant the sole
assessdrent date,current year assessment date,current year date of application legal or equitable owner?
$25,000 ®Yes ❑No
If no,what is hie/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
WI Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
5/3 Bank D{.f /,, A)° 6741
74 ./ —Xcc
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) C•f /`� ��/ / T O
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Name of assignee or other owner or holder of mortgage is ._.�'-"��^'�" ^ '7 .�
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Address of assignee(number and street.city state,and ZIP code) , / r (j2!/ 1 N�2 JJ /Y fu__, v
Does applicant own properly in any If yes,what county? What Taxing District' �. u w 0
ineIndiaana? ❑Yes in No i cu,,.m,r radii r -- ._,.-- I rr—'�1
A person is not entitled to this deduction unless the person has a balance on the person's mortgage ct indebtedness that is recorded in the county I T
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)th " the basis for the deduction. ����11 jiii3
COUNTY AUDITOR (7
Deduction approved In the amount of:
20 20 ' 20 20 20 20 20
�Sq ture of County Auditor �i County Data(month.day,year)
iCA61-00 �'ir V1 f Gibson /Z- 22' 202/
I/ e certify under the penalty o perjury that the a and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned pr'ope on date application is filed.
f: �ag�nam+ls Date(month.day yam)
r" ..)1�� t t.�t.-..� 102-24)dz/
Full resident address of apptic., (number and street city,state,end ZIP code)
1408 S Metro Dr.,Princeton,IN 47670
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person(number end street.city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years end a fine not to exceed$10,000.