HomeMy WebLinkAboutMortgage_LLC (10) 44`"'ry• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i FOR DEDUCTION FROM ASSESSED VALUATION (o
State Form 43709(R14/1-20) Gibson a 2022
'N.- _ = � RECEIVED
.. Prescribed by Department of Local Government Finance
` ) File Mark
INSTRUCTIONS: To be filed in person or by mail. .l y ` l t o. APR 1 9 2022 Form filed with:
Filing Date: Form must be completed and dated in the llender year for which the deduction is sought. ❑ 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 the property taxes are first due and payable. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
GAW Properties LLC
Taxing District Key number/legal description Record n ber Pa a ber
Pam' 0 2,S 26-12-07-404-002.019-028/Lot 23 Monroe Homes Add t
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?
$71,000.00 $78,000.00 )4Yes 0 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: s the property in question.Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
FILE
The First National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1515 W 9th St, Mount Carmel, IL 62863 APR 1 9 2022
Name of assignee or other owner or holder of mortgage
a.14 ..�/
Address of assignee(number and street,city,state,and ZIP code) GIBBON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti en requested If yes,state amount of deduction
other county on property for
in Indiana? current year?
❑Yes No Yes ❑ No
A person is not entitled t this deduction unless the person has a balance on the person's mortgage or c t 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 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 afi'( th,day.Year)
Crl t lS Gibson rbsi dd��iZ
I/We certify under penalty of perjury that the above and foregoing information Is true and correct and that the applicant Is a nt of Indiana and
owner/contract buyer I the aforementioned property on date application Is filed.
Sig turns e)C ,L�s Date fipoLrt/Z•cl�y�year)
��jj 1 r? L/ � e�� 1_/` ef ZZ
ull resident addre of applicant(number and t,city,state,and ZIP c e
510 S Stout St, Princeton, IN 47670
Person authorized by duly executed Power of Attomey 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.