HomeMy WebLinkAboutMortgage_Fraize 1 • ,... STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t ry;i, FOR DEDUCTION FROM ASSESSED VALUATION RECEIVED Gibson Patoka ( 2021
> State Form 43709(R14/1-20)
Prescribed by Department of Local Government Finance _ DEC 1 5 2021 File Mark
"1
INSTRUCTIONS: To be filed in person or by mail. `�f, \ j ( „� o filed with:
Filing Date: Form must be completed and dated in the calend)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. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Charlene Fraize
Taxing Distripl�"' ` Key number I legal description Record`number PaargG numberp
Patoka ` .,. 26-11-14-101-000.542-027/Lt 9 Sec 2 Columbia Village 2-7956 L••(J (,, /13 '"L[ U U
Assessed value of real proper 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?
$0.00 $145,825.00 y9Yes ❑ 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 t e property in question:Annually Assessed
Real Property 0 Annually Assessed
Name of mortgagee or contract seller
FFILED
Mobile Home(IC 6-1.1-7)
Fifth Third Bank, National Association, ISAOA
Address of mortgagee or contract seller(number and street,city,state,and ZIP Coq�}-t+ A 9 2021
5001 Kingsley Dr. Md:lmoba8,Cincinnati, OH 45227 LJGI. fi
Name of assignee or other owner or holder of mortgage c..4'
/)2. .a.•./ �'. ,,)MY.' :-
Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY AUDITUR
Does applicant own property' any If yes,what county? What Taxing District? • Has this deduction en requested If yes,state amount of deduction
other county on property for Yes CI NO
in Indiana? ❑Yes O current year?
A person is not entitled o this deduction unless the person has a balance on the person's mortgage or contr 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 is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Au rtor - County Date( ggtF�,_d y,..year)�
)'� 1/��-5 Gibson 12' �J-U\
I/We certify under penalty of perjury that the ab• - .•d foregoing information Is true and correct and that the applicant is a resi ent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signatur ow er's full ame) _.,..�•- Date m nth, a y ar)
Full resident address of applicant(number t,city,state,and ZIP code)
1800 W Burlington Place, Princeton, IN 47670
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 inn.Inrfv imnricnnmvnt ern to n..n fl.,,r.fu.if wears and a fine not to exceed$10,000.