HomeMy WebLinkAboutMortgage_Mosley (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION Gibson Oal513rul-eltSe' 2022
T,4,,,, ,, State Form 43709(R14/1-20)
$,.. Prescribed by Department of Local Government Finance RECEIVED
File Mark
INSTRUCTIONS: To be filed in person or by maige_frofvE o filed 7 FEB 1 G 2022
Filing Date: Form must be completed and dated in the c ndar year for which the deduction is sought. Countid with:
Filing
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 the property taxes are first due and payable. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Tracey Mosley
Taxing District —..\-------V:In Key number/legal description Record number Pagapumber
WWI Pek
Oa City . 26-14-18-204-000.360-006/Pt SE NE 18-2-8(1.35 A) 7%0 2. '2._ ...b.5-0
ssessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is ap icant the sole
assessment date,current year assessment date,current year date of application leg o uitable owner?
$113,700.00 $178,787.00 Yes CI 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: t property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller FILED
Bank of England, ISAOA/ATIMA
Address of mortgagee or contract seller(number and street,city,state,and*ZIP co
P.O. Box 3490, Little Rock,AR 72203 FEB I 02022
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
GIBBON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti een requested If yes,state amount of deduction
other county on property for
in Indiana? El Yes El No current year? Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage o con act 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
1 20 20 1 20 20
Signature of CouMuckZcAtkii ri...s , County Date5...o th,da iLari 2_,
i/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a rest nt of ndiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si ature(o\r's full name) in Date(month,day,year)
----"c4 1-3 /Full resident resident address of a nt(number an reef,city,state,and ZIP code)
12422 E 100 S,0 land City, IN 660
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 nanalties for neriury can include imorisonmant no in'Iwn and a half 1,aat,and a fine not to exceed$10,000.