HomeMy WebLinkAboutMortgage_Goldman (2) i~t= mq„,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
s, i', FOR DEDUCTION FROM ASSESSED VALUATION
�°�` RECEIVE aSo
t �" State Form 43709(R 13/10-15) v OO,r' �7.�r�
2.
' `, _eY Prescribed by Department of Local Government Finance I��JG
INSTRUCTIONS: l ` APR 0 8 2022 File Mark
To be filed in person or by mail. f 1\L✓�_ ���^^'���` Form filed with:
Filing Dates: 1) Real Property:Must b mpleted and dated in the calendar ear which the deduction is sought.
Must be filed or postma ed with the County Auditor or County Recorder of the county where the property is )(County
County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Goldman,Steven Austin
Taxing District Key number/legal description Record number Page num r
Francisco 26-13-20-101-000.277-005/M&C ADD 13/14 PT QJ0 2 2 l (7)
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I 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'?
94600.00 90919.00 163.975.00 Y 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 applicant,indicate below: F I L T D1 Is the property in question:Annually Assessed
■fL1,' 1 x Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Equity Prime Mortgage.LLC APR 1 3 2022
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
PO Rnx 1194.Snrinefield.OH 45501-1194
Name of assignee or other owner or holder of mortgage v CZ.1'YU
GIBSON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own prope in a If yes,what county? What Taxing District? Has this deductict peen requested If yes,state amount of deduction
otin Inc county on n yea for it
in Indiana? ❑Yes No current year? LIroprIttYes ❑No
A person is not entitled to thi deduction unless the person has a balance on the person's mortgage or ract 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 r County \ Date m th.d y ear)
iNficdtAASIS 6 ,.3.1/4* n 4 12_ 1,02.2-
I/We certify under the penalty of perjury that the above and foregoing information t e and correct and that the applicant i a re dent of Indiana and
own r/contract buyer of the aforementioned property on date application is Red.
Sign re owner' II na (( th day.year
5.
A
ull sident ddress of applicant umber and street.city.state.and ZIP code)
108 S Cross St.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,and ZIP code)