HomeMy WebLinkAboutMortgage_Brewer (7) a 77- • STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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f.1 FOR DEDUCTION FROM ASSESSED VALUATION RECEIVED Gibson 0 2022
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State Form 43709(R14/1-20)
Prescribed by Department of Local Gov{9cG[)�ent Finance MAY 1 1 2022 File Mark
INSTRUCTIONS: To be filed in person or by mail. 1 lO 1 F filed with:
Filing Date: Form must be completed and dated in the calendar 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. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Joshua R.Brewer
Keynumber/legal description Recordr nnlmber tag euq��i Ir
Taxing District �. f.(J 6l
Oakland City 26-14-18-102-001.162-007/MARION HEIGHTS 5
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is1e he appl cant thee sole
assessment date,current year assessment date,current year date of application 9
$0.00 $177,272.00 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
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If name on record is different than that of applicant,indicate below: F I L T t
Reaprolp Propertyertyinquestion
❑An:Annuallyn ually AssesAssessedsed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc. 022
Address of mortgagee or contract seller(number and street,city,state,and ZIP co e)
501 N.Cross Pointe Blvd., Evansville, IN 47715
Name of assignee or other owner or holder of mortgage COtjn1TY AUDITOR
(MBSON
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction en requested If yes,state amount of deduction
other county on property for Yes ElNo
in Indiana? CI Yes ❑ NO current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or on act 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`w 20 20 20 20
ature of County Auditri t _(1 c ` a County Da o day,Year)
Gibson S '
I I We c ify under penalty of perjury that the above and foregoing Information is true and correct and that the applicant Is a r id nt of Indiana and
own c ntract buyer of the aforementioned property on date application is flied. Dat mont day,tear)
S' n u ( per' ull name) j Z( ?'
J 1 v
Fu I residen ddress of applicant(number and street,city,state,and ZIP code)
830 N. Main St., Oakland City, IN 47660 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 oeriury can include imprisonment un to two and a half years and a fine not to exceed$1 0,000.