HomeMy WebLinkAboutMortgage_Hicks (4) ,�^•••,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
s%" FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20) Gibson Francisco 2022
;— ✓'' 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. 10 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
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Applicant(owner or contract buyer-see restrictions on reverse side) (
David N &Angie Hicks
Taxing District Key number/legal description Record number Page number
Francisco 26-13-17-303-000.258-005 2022 1120
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?
$ 175,400 Ikl 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: Is the propert in question:Annually Assessed
La rty ❑Annually Assessed
{L.\ MobileeHome(IC 6-1.1-7)
Name of mortgagee or contract seller
Mutual Omaha Mortgage Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 9 2022
APR 2
Name of assignee or other owner or holder of mortgage L
Address of assignee(number and street,city,state,and ZIP code) G .oLO� CO VI-OR
N-tY AUL)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for I� ❑
in Indiana? ❑Yes No current year? Yes No
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 r�onth j�year)
VA .�J\ Gibson I2 ��].�.J\ ?
I/We certify under the penalty of perjury that a and foregoing information is true and correct and that the applicant is a resi ent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
t
ture owners full nam ) Date(month,day,year)
Full r ident add ss of applicant(number and street,city.state,and ZIP code)
412 Division 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10.000.