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HomeMy WebLinkAboutMortgage_Backman , STATEMEf )EBTEDNESS County Township Year Mkt FOR DEDI 5 '�,{ rn A-N, �j�j State Form 4370! Gibson Ft. Branch 2022 S. Prescribed by I File Mark INSTRUCTIONS: To be filet � /8(l Form filed with: Filing Date: Form must bt v' deduction is sought. Fl County Auditor Must be filed 9r of the county where the property is located on or rty taxes are first due and payable. ❑ County Recorder See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Robert A. Backman Taxing District Key number/legal description Recordnumber Page number nu number Ft. Branch 26-18-24-202-000.128-026 a a. . ` b cTQ Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is t applicant picantthe owner?Bole assessment date,current year assessment date,current year date of application legalequitable $100,500 RIYes ❑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: e property in question:Annually Assessed RBI Prpperty ❑Annually Assessed -if) Mobile Home(IC 6-1.'I-7) Name of mortgagee or contract seller Mortgage Connect �q�, Address of mortgagee or contract seller(number and street,city,state,and ZIP code) p Name of assignee or other owner or holder of mortgage GfeSOR CO CO_`�J,AA7`` O�� Address of assignee(number and street,city,state,and ZIP code) ii/V ry,�Of � R Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction othInder iana?county ❑Yes ©No oncurr proent yearperty for. 0 Yes ❑No in 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 „ 0 Count Date(m th day,p ear) I/We certify under the penalty of perjury that the above and foregoin nformation is true and correct and at the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. ignatu n(ower's full name) Date(month,day,year) n _ f `�O 05/09/22 Full resident address of applicant(number and street,city,state,and ZIP code) 104 W Oak St., Ft. Branch, IN 47648 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.