HomeMy WebLinkAboutMortgage_Conner r__„ . STATEMENT OF MORTGAGE OR CONTRACT I y DEBTEDNESS County Township Year
' <-�> FOR DEDUCTION FROM ASSESSED VALUATI o N
C ". State Form 43709(R14/1-20) `��� Gson 027 2022
''-- Prescribed by Department of Local Government Finance �I►
M� r :01 is File Mark
INSTRUCTIONS: To be filed in person or by mail. [ (� ~ J `'�'t Form filed with:
Filing Date: Form must be completed and dated in theta%ndar�for whi4 the deduction is sought.9 m 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 thet propertyty taxes are first due a ayable. �(n� ❑ County Recorder
See reverse side for additional instructions and qualifications. j V,S `� 1' ,-�I"\ �� G-( ` L-_ -
Applicant(owner or contract buyer-see restrictions on reverse side) 1 M� �^ "�/"� 2
Ronald/Millicent Conner )' Cam) 4' S`''i C- �` , cam\+
Taxing District Key number/legal description / Record number Page number
027 26-11-12-400-000.865-027 2022 310
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is t applicant
equitabl the e owner?
sle
assessment date,current year assessment date,current year date of application legal
149,000 Gil Yes ❑No
If no,what is his/her exact share of interest? If owned with someon other tharl%pouse,indicate with whom
If name on record is different than that of applicant,indicate below: r) \� V ` (� Is the property in question:Annually Assessed
v \ .�+ Real Property ❑Annually Assessed
{1'�f `Q 1S. IL
MobileMome(IC6-1.1-7)Name of mortgagee or contract seller v-'- F First National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) DEC �7 Q 1. �"l 4o`L1
Name of assignee or other owner or holder of mortgage -
c44,14.4 UNYY t.ID A
Address of assignee(number and street,city,state,and ZIP code) GWBS"N CO
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other unty on property for
in Indiana?co El Yes El No current year? ®Yes D No
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:
20 20 20 20 20 20 20
Signatur un AlJdit CC0—
` County \ Date(month,day,year)
(`! !!�, __} 12/31/2021
I/We certify under the penalty of perjury that the above and foregoing information ise and correct and that the applicant is a resident of Indiana and
o r/contra t uy of the aforementioned p on date a rCpp�Itt)Ica�t7ion^is fily�d. ti S
Si n re(owner's WI me i ;�G."V�.." 'I Q I t^ Date(month,day,year)
��� � O. ein .Siyfl1 ct� n ,/ 12/31/2021t
Full r sident address of applicant(number and street,city,state,and ZIP code) U �,t (I�\(o__r�l „��
513 S 3rd St, P'ton, IN 47670 \ �a-/�`� YJ`Cltl�x IItFFF�����,
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 .�d 7 . �;tm fQ\, ®.I a(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) ,tJt '•\ \u 1 VC.iC -
The penalties for penury can include imprisonment Up to two and a half years and a Fin. ^^++^^-^^^^'""^^^^