HomeMy WebLinkAboutMortgage_Harris (5) .M.:._ q, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a • FOR DEDUCTION FROM ASSESSED VALUATION RECEIVED Gibson OZ
State Form 43709(R14/1-20) 2022
s,..;ae_ -- Prescribed by Department of Local Government Finance
C JJ'I�I•V -r MAY 3 1 2022 File Mark
INSTRUCTIONS:To be filed in person orby mail.
Form 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)
Michael J.Hams
Taxing District Key number/legal description Record number Page
Page number
021 26-10-36-101-001.270-021 d b Y 1J 39-3-
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is theoapplicant the er?sole
assessment date,current year assessment date,current year date of application e9
al242,250.00 Yes ❑ No
If no,what is his/her exact share of interest? F
T If o■wnTed�with someone other than spouse,indicate with whom If name on record is different than that of applicant,indicate below: IL L the property in question:Annually Assessed
eat Property ❑ AnnuellHome(IC 6-1.1-7)
Home(IC 6-1.1-7)
Name of mortgagee or contract seller MAY 3.1 2022
Bank of England Mortgage
Address of mortgagee or contract seller(number and street,city, to and ZIP co(�dq/,� iiiritkmd..)
P.O.Box 3490,Little Rock,AR 72203 GtBSON OVNTY AUDITOR
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own prope in any If yes,what county? What Taxing District? Has this deductio b n requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes o current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or on 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 t Date(mont day, ear)
Ml,�a tv�i U -�o'^ 31�21-
I/We certify under the pe Ity of perjury that the above and foregoing information is true and correct and that the applicant is resilient of Indiana and
owner/contract bu er, the forementioned property on date application is filed.
Date(month,day,year)
ignature(owner's ful " )
May 20,2022
„Xi
Full resident add ess o app' nt(number and street,city,state,and ZIP code)
6657 West 400 Sout ,Owensville,IN 47665 Date(month,day.year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
May 20,2022
Address of authorized person (number and street,city,state,and ZIP code)