HomeMy WebLinkAboutMortgage_Price (3) -.,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
x FOR DEDUCTION FROM ASSESSED VAL ON
Q' ' State Form 43709(R14 1 1-20) (/�Q Gibson i (� 2021
_ ,
;ii.' - Prescribed by Department of Local Government Finance "�•` '� RECEIVED
by ) �,G`I y 13 JAN 0 4 2022• File Mark
INSTRUCTIONS: To be filed in person ormail.
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. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
DAELAINEY PRICE
Taxing Districe ,2: Key number/legal description Record number Pr nymn r r�
yP 26-12-18-301-003.026-028 '7-..3 2 C//V//(�)j
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 equi owner?
156,464.00 LWY-es ❑ 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: T i Is t property in question:Annually Assessed
T Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r
CALIBER HOME LOANS INC. JAN O J ad
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
1525 S.Belt Line Road,Coppell,TX 75019 �/hde.4,g4I a,. .....
Name of assignee or other owner or holder of mortgage GIBSON COUNT.... AUDIF'QR
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in If yes,what county? What Taxing District? Has this deduction n requested If yes,state amount of deduction
other county on property for
in Indiana? El Yes No current year? es ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ont 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 Audit_ ('�/�,�..t ��( � County \ C 0 Date( o ay,year)
I/We certifyunder the penalty of perjurythat the\above and foregoing information is tr]/te\'annd correct and that the applical t is a esident'G/c of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
ignature`�ner's fu I nor tie
Date(montD day,veer)
December 17,2021
Fu residen address of applicant(n mber and street,city,state.and ZIP code)
1501 S Washington Ave,Princeton,IN 47670-2939
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month.day,year)
December 17,2021
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant N.me of art agee or contract seller
DAELAINEY PRICE
r ' 33
Date filed(month,day,year e 2 n Amount of indebtedn :''..+',./ Taxing Districn 2 • O M
Key number/legal desgiption
JAN 0 5 2022 \ - ��
�.�2 2
26-12-18-301-003.026-028 ~
Signature of County Auditor/C IR\e er _ County \ ,, Date )4rt(m n a
GIBSON CO -7. -..:.:;TOR