Homestead_Rowlett �.."—"'o. STATEMENT OF MORTGAGE OR CONTRACT INDEBTE NESS County Township Year
yy° i`,e FOR DEDUCTION FROM ASSESSED VALUATION (� 2022
i�- 1'1. State Form 43709(R14/1-20) RECEIVE4ANDE u on �..J -_
'a ,,,,,-x, Prescribed by Department of Local Government Finance
6-: ,60,(01-q-ni File Mark
INSTRUCTIONS:To be filed in person or by mail. FEB 0 2 2022Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction iig 022 (� County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county ere th roperty
is located on or before January 5 of the calendar year in which the property taxes are rst due an ayable. ❑ County Recorder
A tor's Offic
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Ryan T.Rowlett
Keynumber/legal description Record number Page number
Taxing Di tri J
26-14-18-403-000.234-007 2 b C..� (j�)&"f Z5CO
Assesse value of real property as of Mortgage/Contract indebtedness unpaid as of ate f Mortgage/ ntract indebtedness unpaid as of Is legal a pli nt the e sole
assessment date,current year assessment date,current year (,�
er?
75,757.00 '�./ 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:
Ike property in question:Annually Assessed
eal Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller F I L
Bank of England Mortgage .ED -,,i
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) t� Qc\\..
l./
P.O.Box 3490,Little Rock,AR 72203 FFB 0 2 2022
Name of assignee or other owner or holder of mortgage
is
Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY AuiDITOR
Does applicant ownproperty in any If yes,what county? What Taxing District? Has this deducti,ren requested If yes,state amount of deduction
other county on property for
in Indiana? Yes ❑No current year? Yes ❑No
A person is not ntitled to this deduction unless the person has a balance on the person's mortgage . c.ntract 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 offi e) .at is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20
20 20 20 20 20 20
Q County0 ( O ^ Date o tl1 d ,y@ar)
Signature of County A itor �� V1S ` ✓ 1l'' / '�I I We certify under the'penalty of perjry that the above and foregoing information is true an `correct and that the applicant' a r sident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. Date(month,day,year)
Si a(ow name_,\ �..---.'_'..
January 18,2022
I resident address of applicant(number and street,city,state,and ZIP code)
126 South Jackson Street,Oakland City,IN 47660 Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
January 18,2022
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 I • - -=1.7 —
////
Ryan T.Rowlett
Name of applicant a e mort ge c act seller 1 ///
BiIt.�C 9 E I L ID MORTGAG.Date filed(month, y Amount of indebtedness Taxing DistrN '. 2022 i7C
75,757s9B n 0 2 2022 007 _
cr 7 �rGGDD r'a {
Key number/leg I des ription e•"C 2+_r r�+c, /_ Auditor's • ice O n
26-14-18-403-0 0.234-007 �,! (,•. .-7 �R ',_ �;-t;,r:;:. Da!t'e�(� nth, a year)
Signature of County A itor/ w�.tnty'= • +-r a.uu1TOR �-' 2.
GIBSON COUN`i r