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M- �*. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Toyonship Year
�� 1 FOR DEDUCTION FROM ASSESSED VALUATION ^ r
dtitio. ' State Form 43709(R14/1-20) Gibson Q / L -39
223
Prescribed by Department of Local Government Finance RECEIVED !!!//C
personby CAk1+tf 01 JUL / 4 +01-- File Mark
INSTRUCTIONS:To be filed in ormail.
F m ed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property County Auditor
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ ounty Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
David Kemper
Taxing District 0 210 Key number/legal description R Record number Page number
26-18-13-402-000.906-026 ( 'JIa/6 O DA V O
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applican the sole
assessment date,current year assessment date,current year date of application legal xuitable owner?
67,155.00 Yes D 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 the property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �T
American Financial Resources,Inc.,ISAOA/ATIMA and The Secretary of HUD L
r
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
9 Sylvan Way,Parsippany,NJ 07054 JUL 14 2022
Name of assignee or other owner or holder of mortgage
•Thi.„4ec� a_ ���t�0
Address of assignee(number and street,city,state,and ZIP code) G,BSON COVp1TY A
Does applicant own prope in a.y If yes,what county? What Taxing District? Has this deductio e equested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 74,.. current year? es D No
A person is not entitled • this deduction unless the person has a balance on the person's mortgage or ont 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 offi e)tha 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 1 Date n ,-4y, 6qr)_ ^ L
C�IkI.IL1nvu ,sc.., /Lil -°2
of perjurythat t e above and foregoing information is tru d correct and that the applicant i a resi nt of Indiana and
1/We certify under the penalty
owner/contract buyer of the aforementioned property on date application is filed.
ignaturwner's full name) Date(month,day,year)
/ ) � July 5,2022
Fuli resident address o/f ap li number and street,city,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
July 5,2022
Address of authorized person (number and street,city,state,and ZIP code)