HomeMy WebLinkAboutMortgage_Dickerson (2) ��=F4, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1�^' FOR DEDUCTION FROM ASSESSED VALUATION
h State Form 43709(R14/1-20) . -- Gibson 0 Zg — --.c'Z2
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- 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. m 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)
Daniel D. Dickerson
Taxing District Key number/legal description Record number Page number q
Princeton 26-11-12-204-000.971-028 o(OZZ- 2 1-00
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 o e u,table owner?
$76,000.00 Yes IFNo
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 property in question:Annually Assessed
FIE�J Real Property ❑Annually Assessed
J ■LJ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Springs Valley Bank & Trust Co ISAOA/ATIMA JUN 1 0 2022
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
1500 Main Street, Jasper, IN 47546 ((,,�
Name of assignee or other owner or holder of mortgage . %f4,[ Z. jj/__4. ../-
GtBSON COUNTY AUDITOR
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 deductio een requested If yes,state amount of deduction
other county on property for Yes 0 No
in Indiana? ❑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 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 AuditorM • County JD Date� t�dlyyear)2^Z
I/We certify under the penalty of perjury that above and foregoing information is trt e�tnd correct and that the applicant's a r stdent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signal (owner's full na )� Date(month,day,year)
c�et"Vi���� 06/10/2022
Full resident address of applicant(number and street.city state.and ZIP code)
Daniel D. Dickerson
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Daniel D. Dickerson Springs Valley Bank &Trust Co ISAOA/ATIMA
Date filed(my� ,dayear) Amount of indebtedness Taxing District
L� O j ZL $7 (10-
Key number/1 gal d cription
26-11-12-204-000.971-028 1 n' q `�Z� --Z9�7 0
Signature of County Auditor/Couif\Rec rd�� 4`,1h'(y 1 O LO22 Date onth,day.year)
�'l T` G'son b• lQ -2'-2—
&.J4UDI .'_ 1
GIBBON COUNTY AUDITOR