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HomeMy WebLinkAboutMortgage_Lewis (21) �`-:., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year SOR DEDUate Form CTION)FROM ASSESSED VALUATION AECEIVE® C� �2Z Gibson E ie Prescribed by Department of Local Government Finance FEB � 4 File Mark INSTRUCTIONS: To be filed in person or by mail. i f J1(jam Q4� Form filed with: g Filin Date: Form must be completed and dated in the alend4MCY,e€rr for which the deduction is sought. © County Auditor Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is El County Recorder 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) Ashlee D. Lewis Taxing District Key number/legal description Record Page Princeton 26-12-18-103-001.734-028 2?— Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Ie s the applicant equitablethe sole hl assessment date,current year assessment date,current year date of application 9 er? $121,212.00 ®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: Is the property in question:Annually Assessed FIED TL ®Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Bank of England Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 1'4 ZUZ2 5 Statehouse Plaza,#500, Little Rock,AZ 72201 FEB11�-GGG Name of assignee or other owner or holder of mortgage e -,',:;;._..✓ Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNT"( AUDITOR Does applicant own property in any If yes.what county? What Taxing District? Has this deductio n requested If yes,state amount of deduction r on property for Yes 0 No in ot Ihnediana?county ❑Yes ©No current year? A person is not entitled to this deduction unless the person has a balance on the person's mortgage or n tact 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)th is the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of County A ditor County Date d ,year) \el y� �� 2 2-. the above and foregoing information is u and correct and that the applicant a r ident of Indiana and I/We certify under the penalty of p ury that 9 owner/contract buyer of the aforementioned property on date application is filed. Date(month,day,year) Signature(owner's full name) 02/1 1/2022 Full resident address of applicant(number and street,city.state,and ZIP code) 1136 Virgil Blvd., Princeton, IN 47670 Person authorized by duly executed Power of Attorney or by IC 6-1.t-12-0.7 Date(month.day,year) 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 INDEBTEDNESS Name of applicant Name of mortgagee or contract seller Ashle D. Lewis an d In 1� Amount of indebte e�s Taxing District i0 Date file (front, ay,year - )1t` 1 Princeton —' C) or- C Key nu er/I al description FEB 14 2022 -; .2_ g 26-12-18-10 -001.734-028 Date( pnth.(day,year) Signature of County Auditor/ unt or County 7�f r `� GIBSON COUNTY AUDITOR