HomeMy WebLinkAboutMortgage_Krieg (10) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
444:3kIN FOR DEDUCTION FROM ASSESSED VALUATION
1"'itiro,i, State Form 43709(R14/1-20)
-M Gibson 0 23 2021
Prescribed by Department of Local Government Finance il.> _
e....--,, .„..,—.. f___ File Mark
INSTRUCTIONS: To be filed in person or by mail. kr_ I ,.... CIA1.-S. 10%C.C.- •
. I
. . Form filed 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 11,1 County Auditor
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. U County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
MATHEW T.KRIEG
Taxing District Key number/legal description , rd n ber
AD E‘ Page3lurrlet:.5..._._.
Fe i tuthen 26-12-07-201-000.969-028
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicanj.$4 sole
assessment date,current year assessment date,current year date of application legal ore - le owner?
Yes CI No
If no,what is his/her exact share of interest? F][. Ed 9.m98e5one°other than spouse,indicate with whom
property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: JAN 2 0 2022 iis7
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 41)24C114U1 a.
ACCEPTANCE HOME MORTGAGE,LLC GIBBON COUNTY AUDITOR
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
1221 N.Royal Ave.,Evansville,IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,si
Does applicant own property in y e yes,wi c I .„. -- b en requested If yes,state amount of deduction
other county
in Indiana? LI Yes No CO Yes El No
A person is not entitled to this deduction ut nt ct indebtedness that is recorded in the county
recorder's office(including any home equit —1---- 'that's the basis for the deduction.
Deduction approved in the amount of:
20 20 ,( (3 \ - —_ 20 20
— ,
Signature of County Auditor County ......\ Date(mep.day,year)
Cf) -100 .--)1kkTil S Qs- ,_ k-DC' k —- ---o —2 cD.2._
1,We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signatu owner' full name), .._,..z.
Date(month,day,year)
October 29,2021
II resident address of applicant(number and street,city,state.and ZIP code)
513 N Seminary St,Princeton,IN 47670-1743
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month.day,year)
October 29,2021
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 STATEME i-, so--T ,... .. 0„.•NTRACT INDEBTEDNESS
Name of applicant ;=' Nam -or ontracti seller i 1
MATHEW T.KRIEG , T,gtn,.,
Date filed(month,day,year) Amount of indebtedness .. Taxing Distr
_ a /,5)
- 2,0 • 2--0 2- 1 JM,92.4 2022 (.9 z- ---
.
Key number/legal description .
26-12-07-201-000.969-028 Yhw-ftful •e-',,.101, • ,1,4) r-2-'Ci 2-\ - c -
SS 4----> ..-
1.--.2
Signature of County Auditor/Cou y Re rder
R GIBSON Cr.TrAS,At!cr,(T4-..\. Date(month,day,year)
—1---- .2--