HomeMy WebLinkAboutMortgage_Bailey (19) ,.(0,`:""a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
xF Gibson Mon 2022
State Form 43709(R14/1-20) ��
��.%a'. 1 Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Fo 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)
Kordell Bailey
Taxing District Q ^� Key number/legal description Record r Page number
M ornery 2 26-18-07-103-000.121-022/Pt NW 7-3-11 ZZ GG.. 2 8
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 uitable owner?
$67,600.00 $73,641.00 legal
❑ 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: s e property in question:Annually Assessed
Real Property ❑Annually As
I FLED
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)JU N 2 $2022
711 Main Street, PO Box 360,Jasper, IN 47546
Name of assignee or other owner or holder of mortgage L '
Address of assignee(number and street,city,state,and ZIP code) OIBSON COUNTY AUDITOR
Does applicant own property i any If yes,what county? What Taxing District? Has this deducts• , en requested If yes,state amount of deduction
�, on property for i. Yes ❑ No
in Indiana?
other coun 0 Yes O current year?
A person is not entitled t this deduction unless the person has a balance on the personas mortgage or on ct indebtedness that is recorded in the county
recorder's office(includi g 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 ,� . ,_►I► County D�te�i»gr,�{h•17,6y� <7`�\ \vim)\ (1 Gibson /v! LVtC. ,I I We certify under penalty of perjury that the above and foregoing information Is true and correct and that the applicant Is a re dentdiana and
owner/contract buyer of the aforementioned property on date application Is filed.
S' (o full Da[e(rgo dd).y,year)
ull resi address of applicant(nu nd nd street,city,state,and ZIP code) tll//1 ll/ 'C�Jf'/6//Jj�
509 E Montgomery Street,Owensville, IN 47665
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 Sin nnn