HomeMy WebLinkAboutMortgage_Brown (25) .M' '. 4. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Town hi Year
FOR DEDUCTION FROM ASSESSED VALUATION
Gibson 2022
State Form 43709(R14/1-20)
%ai. Prescribed by Department of Local Government Finance
\ File Mark
INSTRUCTIONS: To be filed in person or by mail. l .(,01CCV 3 Cis �( Form filed with:
QS
Filing Date: Form must be comple
ted ted and dated in the calendar year for which the d duction is soug F . 0 County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property El County Recorder
is located on or before January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Joshua A. Brown and Hannah M.Allen
Taxing District '�"� Key number/legal description R or number (� Page number
"'p ar.. f`/7 -/-- CUIN 26-12-18-304-002.059-028/Pt S 18-2-10(.85 A) —OcA`--'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is Is the applicant
te sole
assessment date,current year assessment date,current year date of application 9
er?
$0.00 $153,600.00 ,Yes ❑ 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 the property in question:Annually Assessed
Al Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sellerEA)
German American Bank
Address of mortgagee or contract seller(number and street,city,state, d code)
711 Main Street, PO Box 360,Jasper, IN 47546 FEB 2 �022
Name of assignee or other owner or holder of mortgage F Lv
Address of assignee(number and street,city,state,and ZIP code) ` _,,{
t�.ALtZG[- 6asi�.rT--( AIUD•iD11TOR
Does applicant own property in any If yes,what county? ( $e}fiti�4'biamic[. Has this deduction been requested If yes,state amount of deduction
other county on property for ❑Yes ❑ NO
in Indiana? ❑Yes NO current year?
A person is not entitled o 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
County Datg(mIrt, y, atr aSignature of County Auditor �1�ry , `G7. `+`•! [",` �� GibsonI/We certify under penalty of perjury that the abov d foregoing information is true and correct and that the applicant is a resint Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sign e own same) Date onth,day,year)
Q'��jywrZ� e ' I 1 y"i 1-t l 2 Z ..
resident address of applicant(number and street, ity,state,and ZI code
2108 S Main Street, Princeton, IN 47670 I Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Address of authorized person(number and street,city,state,and ZIP code)