HomeMy WebLinkAboutMortgage_Payne (5) f-w.t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
County Township Year
A t FOR DEDUCTION FROM ASSESSED VALUATION
'� l State Form 43709(R14/1-20) Gson 027 2022
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. 121 County Auditor
Must be filed 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
Applicant(owner or contract buyer-see restrictions on reverse side)
Payne, James M/Eva C
Taxing District Key number/legal description Record number Page number
027 26-11-14-101-001.932-027 2022 1207
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?
54,149 IZYes ❑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
®Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
ETFCU FILED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
MAR 3 0 2022
Address of assignee(number and street,city,state,and ZIP code) 9�%gC ,rrfjj�,,ei� {
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been rent. N UC�VI ite�P b I OFZluction
other county El yes ❑No on property for to
in Indiana? current year? 0 Yes 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 fine 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 to County Date(month,day,year)
ItVtA6 Gson 3/30/2022
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 filed.
Signet re(owner's full name Date(month,day,year)
+• I��r IIIYYY/// 3/30/2022
l/�j�-
Full residen address of applicant(number and reef, ,state,and ZIP code)
1806 mbridge PL, P'ton, IN 47670
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.