HomeMy WebLinkAboutMortgage_Lara (3) r """\ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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s- „,!IA FOR DEDUCTION FROM ASSESSED VALUATION RECEIVE Gibson Princeton 2021
ti,, ..,,,,�, ��!7 State Form 43709(R14/1-20)
�/ Prescribed by Department of Local Gover ent Financ[a FEB 2 9 2022 File Mark
`)
INSTRUCTIONS: To be filed in person or by mail. l
Form filed with:
Filing Date: Form must be completed and dated in the calen a year for which the deduction is sought_ County Auditor
Must be filed or postmarked January
5 County Au or he calendar year in which the property taxes arer County Recorder of the ntyf where
due and payable. County Recorder
is located on or before January 5 of the
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Hannah Renee Lara
Keynumber/legal description Record number Perqucyer
Taxing District ""7^Z`"') ((�C"��,llf(VV''11
Princeton 26-12-17 103-004.242 028 f Lt 9 South Park Sub 2001-1015 f l J L
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is Is tho ap liqcant
the
owner?sle
assessment date,current year assessment date,current year date of application 9
$77, i
$91,315.00 Yes ❑ No
w
If no,whatat iss his/her exact share of interest? F I E i./If owned with
�■■'someone other than spouse,indicate with whom
the property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: II��t,,,,..,, ,�,,....
L7k�Real Property ❑ Annually Assessed
�� )) Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller MAR 0 2 2022
German American Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
711 Main Street, PO Box 360,Jasper, IN 47546 4Y7..-.h,7,-( Cam'. jAd� •"4')
Name of assignee or other owner or holder of mortgage GIBSON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
What TaxingDistrict? Has this de b en requ ed 1 If yes,state amount of deduction
Does applicant own propertyy in any If yes,what county? on property for
other county 0 Yes L2t ND current year? Yes
in Indiana? l
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ract inde tedness 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 aaattt��� jj d2a0y r�
a County D °� t-7�ajr)G✓
Signature of County Auditor ..—�{ �� !J !'hJ ar)r
(�h=' Gibson
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a r si e��Indiana aOa'and
owner I contract buyer of the aforementioned property on date application is filed. '
I Date(month,day,year)
Sign rere(�s full n
Full resident address of applicant(number and street,city,state,and ZIP code)
902 E Ohio Street, Princeton, IN 47670 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)
The penalties for perjury can include imorisnnmon*..-'^...... -