HomeMy WebLinkAboutMortgage_Schriver ,...,, STATEMEN1 - ----""--1(knE OR CONTRACT INDEBTEDNESS County Township Year
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, _ , State Form 43709 I 4/9417(_, Gibson Owensville 2021
'--- Prescribed by Di
INSTRUCTIONS: To be filed _57---1,464 File Mark
Form filed with:
Filing Date: Form must bi ion is sought. IRI County Auditor
Must be filed dA- '''7,9,3 he county where the property is
located on or be tore,..„—., ices 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)
Daniel&Shalea Schriver
Taxing District Key number/legal description Record number Page number
Owensville 26-17-01-403-000.204-022 c 0 c I ISC1 cl
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?
521Yes p 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
Real Property El.foknonbrellizorne
Assessed
A
(IC 6-1.1-7)
Name of mortgagee or contract seller
Mr. Cooper ED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) DE-c, , 4 CI,,
•''' 202/
Name of assignee or other owner or holder of mortgage
GillS4r1-" ,..1,1:1
Address of assignee(number and street,city,state,and ZIP code)
'"NITYALZ:
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested yes,state amount of deduction
other county on property for in Indiana? E]Yes 0 No current year? Yes rj 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)
a _ Gibson 12/28/2021
certify under the penalty of perjury that the above and for oing rmation 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.
•Signr(ow.n till n2).....4tra7..„_,------- Date(month,day,year)
X 12/28/2021
Full resident address of applicant(number and street,city,state,and ZIP code)
307 Crestview Dr, 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)