HomeMy WebLinkAboutMortgage_Pullum (2) .,..._--. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
7 '. FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20) Gibson Johnson 2022
1 .. e. 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. RI 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.
El See reverse side for additional instructions and qualifications. -...\e,=c1...
Applicant(owner or contract buyer-see restrictions on reverse side) \�� C�j�
Angela Pullum �\ �J�
Taxing District Key number/legal description Record number Page iurr>)a
Johnson 26-18-36-300-002.102-024 2. Z �t..-"����[[ll 66 .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is Is the applicant
antthe ee sole
assessment date,current year assessment date,current year date of application 9
$ 134,000 fkl 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 appr pt'-I(t i to below: F� Is the property in question:Annually Assessed
�L T Real Property ❑Annally Assessed
Mobileu Home(IC 6-1.1-7)
Name of mortgagee or
5/3 Bank n /� t�1 ��11 U W� `�A
Address of mortgagee f , t 1 \ l�/� +de) '12
1�`/� I(o 3 _ G/Qso , 202Z
Name of assignee or of �l i�c Q Cf r/ h I(� 4/ O _ / !��
Address of assignee(n, 10 _2- I S 1 of n e Y 40of O .
Does applicant own property in any I If yes,what county? I What Taxing District? Has this deduction been 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 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 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 Date(month,day,year)
��r'1 o D . l� kit k(t � lk� Gibson 1/12/2022
I/We certify under the penalty of perjury that the above and for formation is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date plication is filed.
Date(month,day,year)
nature(owners full name) 01/12/2022
e/-�
II resident ad r ss of applica (nu r and street,city,state,and ZIP code)
10201 S Quail Crossing, Haubstadt, IN
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 nnr to ov' ' x,n nnn