HomeMy WebLinkAboutMortgage_Adamson (10) .&-"i.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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1R :��4, FOR DEDUCTION FROM ASSESSED VALUATION
it State Form 43709(R14'1-20) RECEIVED Gibson 0 2.k `I,o 2.Z..
q.ard:,.% Prescribed by Department of Local Cover ment Finance
j 1 / p I MAR 0 4 2022 File Mark
INSTRUCTIONS: To be filed in person or by mail. ! ( Form riled witty
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. 0 County Auditor
Must be Pled or postmarked with the County Auditor or County Recorder of the county where the properly is County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due and payable.
ED See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jeffrey C. Adamson and Carrie R. Adamson, husband and wife
n
Johnson 26-23-03-400-001 �
.412-024 -2 ?2-- IQ
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$84,500.00 gi Yes ❑No
If no.what is his I 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
■ ®Real Property ssed
Mobile AnnuallHo Home 6-1.1-7)
Name of mortgagee or contract seller , 1 I■s..✓ ■W D
Heritage Federal Credit Union L.`J
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
5388 Old State Hwy 66, Newburgh, IN 47630 MAR 08,2022
Name of assignee or other owner or holder of mortgage �f • a.
Address of assignee(number and street,city.state.and ZIP code) "ifr r,.itiEit u. J-//yam,Cr AUDITOR
OIBSO" CO
Does applicant own property in any If yes,what county? 'What Taxing District? Has this deduction a 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 to this deduction unless the person has a balance on the person's mortgage or c nt ct 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
Signature of County Auditor, _ a
County \ Da .r nth,d y,year), �� ,,,,
I/We certify under the penalty of perjury that the above and foregoing information is trua nd correct and that the applicant is a re ident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
at re(owner' ful name) ,�/� Date(month,day,year)
�0 t5eV't r�. ./f/2 C.-(-- /et. 02/28/2022
Full esid t address of applicant(number and street.city,state,and ZIP cod
10661 S 350 E, Haubstadt, IN 47639
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 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 33
Jeffrey C.Adamson and Carrie R. Adamson ••1a a Fedde'rral Credit Union . in
Date tiled(month,day,year) Amount of indebtedness ■ i ,g District o rn
E(T7� 2Q1,1— $84,5 n l hnson "" ,�
Key number/legal description �i+(12� C9
rn
26-23-03-400-001.41MAR 0 8 702 2-024 2 Y •/ 9— ^a a
Signature of County Auditor/Count ecord r • County _. DateO1 th.day ea 7.12-
4
GIBSON COUNTY AUDITOR