HomeMy WebLinkAboutMortgage_Dodge STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R14/1-20) RECEIVED Gibson Patoka 2021
,...; -,,,- Prescribed by Department of Local Government Finance
INSTRUCTIONS:To be filed in person or by mail. 1
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VAl 1 0\T JAN 0 5 2022 File Mark
F m fil d with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property County Auditor
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)
- - Ruben Dodge
Taxing District Key number/legal description Record number Page number
028 26-11-12-203-001.907-028/BMA 75,Gibson County ;2_,b 2-2-61)0 000 27
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?
32,000.00 Yes El 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: F i 1_,, ii) Is the property in question:Annually Assessed
L
NI Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7) i
Name of mortgagee or contract seller
Springs Valley Bank&Trust Company JAN 07 2022
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1500 Main Street,Jasper,IN 47546 '
Name of assignee or other owner or holder of mortgage
GIBSON COUNTY AUUITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in apy If yes,what county? What Taxing District? Has this deduction en requested If yes,state amount of deduction
other county r---, on property for
in Indiana? LJ Yes o current year? es El No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or nt 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)tha 's the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor s ,....v.----_s County
\ •/-.1\ DatVtnt
1,We certify under the penalty of perjury that the above and foregoing information is tru d correct and that the applican is a re 'dent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature (month,day,year)
--G-.
—4.._--- December 30, 2021
Full resident address of applicant(nu -4.- --,rand street,city,state,and ZIP code)
201 North Eighth Street Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
December 30, 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.