Mortgage_Deisher A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•i° r\ FOR DEDUCTION FROM ASSESSED VALUATION `�Qn ((�V 2022
-j4, ' State Form 43709(R14/1-20)
File Mark
4.,`�.__�� +� Prescribed by Department of Local Government ance �� — ��� r����
INSTRUCTIONS: e_ -
ZZ
To be filled in person or by mail. Form filed with:
Filing Dates: Form must be completed and dated in the calendar year for which the deduction is sought. Cl
be filed or postmarked with the County Auditor or County Recorder of the county where the County Auditor
property is located on or before January 5 of the calendar year in which the property taxes ae 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)
Douglas C. Deisher and Karen K. Deisher
Taxing District Key number/legal description 26-05-35-200-001.835-004/2055 N 465 E, Record numb r Page number
Princeton, Indiana 47670 tP4)- 'Sa
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 citable owner?
$358,500.00 iVees 0 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 th roperty in question: Annually Assessed
Is
Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Freedom Bank FILET)
Adddress of mortgagee or contract seller(number and street city,state,and ZIP code)
1405 N Main St., PO Box 177, Huntingburg, IN 47542
Name of assignee or other owner or holder of mortgage JA A�
Address of assignee(number and street,city,state,and ZIP code) ,y �422
Does applicant own property in any If yes,what county? What Taxing District? Has this dedu2rc y , If yes,state amount of
other county on property forf ry Ai," uuction
in Indiana? ❑ Yes tNI,Xio current year? 0 Yes ❑ itq"dPOR
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:2OUOLY
20 2020 20 20 20 20
Cunt Auditor Date(month,day,year)
I/We certify un er he//penalty of perjury that the a6rro4 and foregoing information is true and correct and that the applicant is a resident of Indiana
and owner/contract buyer o Ise aforementioned property on date application is filed.
St�9/(g��
ture w rs full nn (/ /} Date1(r g1y,
C _ //
Full resident add ss of applicant(numberVeet,city,state,and ZIP code)
2055 N 465 E, 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 include imprisonment up to two and a half years and a fine not to exceed$10,000.