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HomeMy WebLinkAboutMortgage_Ervin (2) • STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cpunty Township Year . E -' �I ©� I 2022 �, , R. , FOR DEDUCTION FROM ASSESSED VALUATION �!� t., V , State Form 43709(R14/1-20) File Mark '4\__ __-f Prescribed by Department of Local Government Finance r �� INSTRUCTIONS: For fi d with: To be filled in person or by mail. Filing Dates: Form 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. Applicant(owner or contract buyer-see restrictions on reverse side) Jesse W. Ervin and Andrea M. Ervin Re rd number f (Page number Taxing District 1Key number 26-12-18-103-004.427-028 rend u _/_/ Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of late of application Contract indebtedness unpaid as of lIs Is then p qu table owner?sle assessment date,current year assessment date,current year date0 No $195,035.00 If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom l I If name on record is different than that of applicant,indicate below: Is troperty in question: Annually Assessed Property El Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Springs Valley Bank&Trust Company Address of mortgagee or contract seller(number and street,city,state,and ZIP code) F ILED 1500 Main Street,Jasper, IN 47546 Name of assignee or other owner or holder of mortgage Address of assignee(number and street,city, state,and ZIP code) APR 07 2022 Does applicant own property in any If yes,what county? What Taxing District? Has this dedu•ion been requested If yes,state amount of o property for 1 deduction inot Indiana?nr county , ��j`A "�'1 No 0 Yes No ]Pi G• TY llDtTn A person is not entitled to this deduction unless the person has a balance on the person's m g"e or/•nt -ct 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 offic that the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount of: I 20 I 20 I 20 I 20 I 20 I 20 20 tCounty \ Date(mon da ,year) Signature of County Audi(or ( y. ,�_ \ C QJ^ IL) 7 --�`nder enaltty off perjury` tabove and f2eoceego�inlg information is true and correct and that e a plicant is a resident of Indiana I/We certify under the penalty and owner/contract buyer of the aforementioned property on date application is filed. Date(moot ,day,7r) Sig atur wner's full name) I 3�a l a a ull r dent a ress of applicant umber and street,city,state,and ZIP code) l 13 0 S Baldwin Ct., Princeton, IN 47670 (Date(month,day,year) Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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.