HomeMy WebLinkAboutMortgage_Payne (2) F MORTGAGE OR
CT
.`���' STATEMENT FOR DEDUCTIOON FROM ASSESSED VALUATION EBTEDNESS County Township Year
-- rGibson Montgomery 2022
yam+.,,;;- State Form 43709(R14/1-20)
stt Prescribed by Department of Local GayerGovernment Finance RECEIVED
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INSTRUCTIONS: To be filed in person or by mail. ( btiNs9JC..... MAR 0 8 2022 File Mark
Form ed with:
Filing Date: Form must be completed and dated in the c\ale .. year for which the deduction is sought. aunty Auditor
Must be filed or postmarked with the County at or 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. f aunty Recorder
See reverse side for additional instructions and qualifications. l
Applicant(owner or contract buyer-see restrictions on reverse side)
Larry Payne
Taxing District Key number/legal description Record number Page number
Montgomery
26-17-01-400-003.815-021 /Pt NE SE 1-3-12 Gco,'2-2— 10 4 3-
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/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?
$94,300.00 $120,000.00 A Yes ❑ 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
,fit Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of a o contract seller
Fifth Third Bank, National Association, ISAOA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Kingsley Dr. Md:lmoba8,Cincinnati, OH 45227
Name of assignee or other owner or holder of mortgage MAR 0 8 2022
Address of assignee(number and street,city,state,and ZIP code) -1 L, --,
r\BO
Does applicant own propert in any If yes,what county? What Taxing DistriSN C®ttotSiY• `.!)�' -•'• .n 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 o this deduction unless the person has a balance on the person's mortgage or.•n -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
C"'J�) County D)))e�Signature of Gounty Auditp[Y 1l_ Vn`'..Jl('�`rr�'.` Gibson
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a re/71
iden d yet
of Indiana and
owner/contract buyer of the aforementioned property on date application Is filed. moth,day,year)
Signature(owner's =me) 'a Date�mo hZ.
Full r'- tent.•dress• applice, (number and street,city,state,and ZIP code)
66_• ' orth St =:. •wensville, IN 47665 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 imprisonment up to two and a half years and a fine not to exceed$10,000.