HomeMy WebLinkAboutMortgage_Dauphin "It STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coiunty Township Year
4 •-' ` - FOR DEDUCTION FROM ASSESSED VALUATION I I
� 2022
� ii��' , ' i State Form 43709(R14/1-20)
'y ��? Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: Fled with:
Filing Dates:To be filled person mail.
Dates:: Form orm must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the County Auditor
property is located on or before January 5 of the calendar year in which the property taxes ae first due 0 County Recorder
and payable.
See reverse side for additional instructions and qualifications. i
Applicant(owner or contract buyer-see restrictions on reverse side)
Marie A. Dauphin
mbenu
R cord nur
Taxing District Key number 26-12-18-103-004.426-028 �j / 59 Page number
Assessed value of property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is Is thel applruitabltee sole
assessment date,current year assessment date,current year date of application g es ❑ NO
$216,227.00
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
Is e property in question: Annually Assessed
If name on record is different than that of applicant,indicate below: Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller A oress fValley
alley Beek&Trust Companyr ILEDAddress of mortgagee or contract seller(number and street,city,state,and ZIP code) 1H
1500 Main Street,Jasper, IN 47546
Name of assignee or other owner or holder of mortgage APR 07 2022
Address of assignee(number and street,city,state,and ZIP code)
If yes,what county? WhatTaxing �u (/ d If yes,state amount of
Does applicant own property in any District? G9tg 03� AU I deduction
other county in Indiana? ❑ Yes No current year? Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or con a t 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 i the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 I 20
CountyDate(rgon da ,yearL ,7
Signature of County Auditor t� ^ 11�� 1 �Q L
MVoa to s - 1
I/We certify under the penalty of perjury tha e above an f regoing information is true and correct and that the plicant is a resident of Indiana
and owner/contract buyer of the aforementioned property on date application is filed. Date(month day,y ar)
ig aF(owner's full name) Ll/' /zO a
Full resident address o plicant(number and street,city,state,and ZIP code)
1301 S Baldwin Ct., Princeton, 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.