HomeMy WebLinkAboutMortgage_Edwards (7) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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a., State Form 43709(R14 I 1-20) Gibson -D0(2-2,
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-,-«*" Prescribed by Department of Local Gover ent Finanrte
att- ti..,,, (1 ..p......0t.,11 tev- File Mark
INSTRUCTIONS: To be filed in person or by mail. Form filed with:
Filing Date: Form must he completed and dated in the calendar y ar for whic th eduction is sought. t 6 -2.1 g, County Auditor
Must be filed or postmarked with the County Auditor or County Recor er of the county where f7e p ope i;
located on or before January 5 of the calendar year in which the property taxes are first due and payable. 1E3 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Lincoln M. Edwards and Keely D. Edwards, husband and wife
Taxing District Key number I legal description Record numb22, Pag
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness u
Center 26-12-11-200-001.505-004n aid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$308,300.00 0 Yes ONO
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
gl Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank FILED
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
711 Main St., Jasper, IN 47546 JAN 0 7 2022
Name of assignee or other owner or holder of mortgage
--i
GIBSON COUNTY AUDITOR
6
r)---- Nhat Taxing District? Has this deductio en requested If yes,state amount of deduction
o on property for
ir Drawer NO 4ii /, Nhat current year? Yes 0 No
—
A ;a balance on the person's mortgage or c tr t indebtedness that is recorded in the county
re 3 recorded in the county recorder's office)that is the basis for the deduction.
_ Card NO. (r3— COUNTY AUDITOR
3........,,,.,.1Jpvt.tvt.J III tile amount or:
20 20 20 20 20 20 20
Signature of County A c:Mr County
Date\mAntb,lay year)
I/We certify under the penalty of perjury that the ,‘-•ve and foregoing information is true nd correct and that the applicant i a resi ent of Indiana and
owner!contract buyer of the aforementioned property on date application is filed. --
Sigr_rArvnerff narr4) Date(mo , ay year)
3 .0 12/29/2021---
Full resident address of applicant(number and street,city,stdt .and ZIP code)
315 N 450 E, Francisco, IN 47649
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 to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Lincoln M. Edwards and Keely D. Edwards . man American Bank
_day.year) Amount of indebtedness
Date filed(month ing District
X- —/ --2-0 1:2-- $308,3 .0II 4 E Denter
Key number/legal description
26-12-11-200-001.505-004 JAN 0 7 2n22
Signature of County Auditor/Count Recorder County Date(month.day,year)
V171, •C),,z,',.sizr,,L,
, . : \ -0,--7 ....._GIBSON COUNTY AUDITOR