HomeMy WebLinkAboutMortgage_Sisson +r; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
,,' Gibson Princeton 2022
State Form 43709(R11 6-09)
%. _�., r* Prescribed by Department of Local Government Finance
'a's
File Mark
INSTRUCTIONS:
Tobe filed in person or
ma
il.
ert. o filed with:
Filing Dates: Realaily: Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the properly is located County Auditor
on or before January 5 of the immediately succeeding calendar year.
2.) Mobile/Manufactured Home not assessed as real Property: Must file with the County Auditor of th County Recorder
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
* Justin Jay Sisson �� RecoSd u b r Page number
Taxing District Key number/legal description r C!J
a2 *NS LOT 2PTR1/a.(0_/; -b7-.�O3--OCR•a38--U
Assessed value of real property as of Mortgage/Contract indebtedness unpaid Mortgage/Contract indebtedness Is the applicant the sole
as of March 1,current year. unpaid as of date of application legal or equitable owner?
March current year *$0.00 *$201,919.00 El Yes El No
* $0.00
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
F Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
* German American Bank
Address of mortgagee or contract seller(number and street, city,state, and Zll�2CR )h 8 2022
* P.O.Box 360,Jasper, IN 47547-0360IrVINN V
-
Name of assignee or other owner or holder of mortgage y a {r
Address of assignee(number and street, city,state, and ZIP code)
GI'B4SON L.JUN AUDITOR
Does applicant own property in any other In yes,what county? What Taxing District? Has this deduction been requested on property
for current year?
county in Indiana? 0 Yes tr No
0 Yes {� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20
20 20 20 20 I 20
1 County 1 Date s t y,y it
Signature of County Auditor r�^1 y 1\�o�}f rN lf�� l✓
I I We certify under the perjurypenalty rofv ` f that the abo foregoing information is true`a d correct and that the applicant is a" resi ent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. Date(month,day,year)
rSignatur (owner's - me� 02/07/2022
resident a applicant(number and street,city,state,and ZIP code)
* 328 N.Seminary St,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)