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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ��irv , State Form 43709(R14/1-20) / r� Gibson 00 LA\`- Prescribed by Department of Local Government Finance 3/23 I�Q ZZ.
./�, /// File Mark
INSTRUCTIONS: To be tiled in person or by mail. �n A�p(�O.',/ &.J Form filed with:
Filing Date: Form must be completed and dated in the calen r year for w ch the deduction is sought. it County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Caleb R. Duncan �
Taxing District Key number/legal description Recorddnnurt er^ Pagg numb
eL-
Center 26-13-21-300-000.795-004 7 C/�' — QV
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is te ao p li nt noble the
sowole?
assessment dale,current year assessment date,current year date of applicationlegal
$127,289.00 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
0 Real Property MobileAnnually Homeessed
(IC 6-1.1-7)
Name of mortgagee or contract seller FILET)
German American Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �A p 2022
711 Main St., Jasper, IN 47546
Name of assignee or other owner or holder of mortgage F VR
GIB
Address of assignee(number and street,city,state,and ZIP code) SO$CO' "+~t ' AVt:t
Does applicant own property in any If yes,what county? What Taxing District? Has this deductio een requested If yes,state amount of deduction
other county on property for
in Indiana? Dyes ®No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or act 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 County 1 C V v 1 Date o tlayy,,y1r)2„0 0 ^ 2_
I/We certify under the penalty of perjury tha e above and foregoing information is t ue and correct and that the applicant a resid t of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig ure oar's MI name) Date(month,day,year)'=�z `J�..�t^ 02/11/2022
ull resident address of applicant(number and street,city,state,and ZIP code)
7597 E State Rd 64, Francisco, IN 47649
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,end 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
Caleb R. Duncan m
Date filed(moot ,day,ye ) Amount of indebtedness � r king District
$127,289.0 enter
Key number/le�al escriltior
2613-21 u300e000.795-00
M^R 3 0 2022 ^`7 � - q C
� MAR L L
Signature of County Auditor/County Recorder County Date( nth,da year)
GIBSON COUNTY AUDI I OK