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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
s ,j stab Fenn 437o0(R14/1-20) Gson 026 2022
4*. Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be Bled in person or by mail. Foam slab with:
FMng Date: Form must be completed and dated in the calendar year for witch the deduction Is sought. ® County Auditor
Must be flied or postmarked with the County Auditor 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 end payable. ❑ County Recorder
See reverse side for additional Instructions and qualifications.
Applicant Owned orcantled buyer-see raadkWona on reverse We)
Howard, Kylie F
Taxing District Key number I legal description Record number Page number
026 26-19-19-101-000.599-026 2022 847
Assessed value of real property es of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid roof Is the applicant the sole
assessment date.current year assessment date,current year date of application legal or equitable owner?
$132,544 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: la the property in question:Annually Assessed
®Real Property 0 Annually
lyMobile Home Assessed
(IC 6-1.1-7)
Name of oral contract seller
Caliberer Home Loans LLC j{�'J
Address of mortgagee or contract sear(number and street dry,sate,and ZIP J
Name of assign e or other owner or holder of mortgage MAR 1 0 2022
Address of assignee(number and gavot city,sate.and ZIPCade)
o�aapa?
ppi nt own properly In any If yes,what county? wtwl ( C Q U .";.. requested If yes,sate amount of deduction
In I lian ❑Yes ❑No car year? J es ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract 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 oMce)that Is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 d(ry� 20
Signature of County Auditorc4) County ate f'l
Gson
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application Is sled.
signMu (((arenn/elr (UNns �) CAALe �/''1'"pOO�f''�J`f_ Date /on day,year)
Full rsakMadaddnM F ppiwny (number andC10.orate,and ZIP code)
03,01 t 20 Z,
403 S Lincoln ST, Ft Branch, IN 47648
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 efts Mate,and ZIP code)
The penalties for perjury con include htps/sonment up to two and a half years and a fine not to exceed$10,000.
RECEIPT FOR RUNG STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of appacaM Name of mortgagee or contract seller
Howard, Kylie F Caliber Home Loans LLC
Date flied(may day year) Amount of indebtedness Taxing District
$132,544 026
Key number/legal description
26-19-19-101-000.599-026 G C_
signature of County Auditor�,,�ae� Recorder County Dale month day year)
`Or) y>c Gson 2 Z
FTLED
�_ MAR 1 020,2.2
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