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HomeMy WebLinkAboutMortgage_Kitchin STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION ,ii `i State Form 43709(R14/1-20) Gibson Montgomery 2021 Prescribed by Department of Local Gover L57 \ �� File Mark INSTRUCTIONS: To be filed in person or by mail. ) 9 I Q 0 t C)O Form filed with: Filing Date: Form must be completed and dated in tt 1 © County Auditor Must be filed or postmarked with the Cot l t A �. (�_\ ./ the property is located on or before January 5 of the cal , \, , I I \ 1` ,nd payable. ❑ County Recorder See reverse side for additional instructions and qualificatic Applicant(owner or contract buyer-see restrictions on reverse side) Alex&Alexandra Kitchin Taxing District Key number/legal description Record number Page number Montgomery 26-17-29-400-000.202-021 2021 6759 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is Is thl he applicant the r equitlea sole assessment date,current year assessment date,current year date of application 9 191200. ®Yes ❑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 AnnuaF.T L 1DrtY ❑Mobile 6-1.1-7) Mobile Home Assessed 6-1.1-7) Name of mortgagee or contract seller Old National Bank Address of mortgagee or contract seller(number and street,city,state,and ZIP code) U E C//2 7 ,22/02 Name of assignee or other owner or holder of mortgage tG�C..G,�i'{r Address of assignee(number and street,city,state,and ZIP code) CIDSON COUNTY AUDITOR Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested 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 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) .Ak a-S,-n a ` " 0 ,\ Gibson 12/27/2021 1/ e certify under the penalty of perjury that the above d foreg'� information is true and correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. Date(month,day,year) Signature(owner's full nam ) 12/27/2021 X I `- Full resid nt address of appli nt(num er and street,city,state,and ZIP code) 9058 S 1075 W, Owensville, IN 47665 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 in.xraer/¢+n nil",