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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS younty Tonship Year
7s- � FOR DEDUCTION FROM ASSESSED VALUATION
IN ^ 2�1: State Form 43709(R13/10-15) ��• ` Q C_�
Prescribed by Department of Local Government Finance RECEIVED G
I( , AUG d 42022 File Mark
INSTRUCTIONS: \
To be filed in person or by mail. an�/,��'O F rm ed with:
o.
Filing Dates: 1) Real Property:Must bdompleted and dated in the ca/e Ra ar for which the deduction is sought. CountyAuditor
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 immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Fox,Meagan Leigh
Taxing Distnc]r`� Key number/legal description Record number Page number
v 26-12-07-102-002.779-028/CHAS BROWNLEE 16 PT 2. 3 7 7_ 4q6
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is Is the
l or p ceant thee sore
asse m e
ssent date.current year assssment date,current year date of application 9
er?
141.414.00 X Yes ❑ 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: T T T Is the propertyo in question:n AnnuallyllyAssessed
11 ■L■ x Real Property ❑ Annually Assessed
J Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Kind Lending LLC AUG 0 9 2022
Address of mortgagee or contract seller(number and street.city.state.and ZIP code) •
4 Hutton Centre Drive.STE 1000.Santa Ana.CA 92707 eJAI;l.l vrul
Name of assignee or other owner or holder of mortgage G'//BS �pUN_re p•UDITOR
Address of assignee(number and street.city,state.and ZIP code)
Does applicant own property in ny If yes,what county? What Taxing District? Has this deduction requested If yes,state amount of deduction
other county on property for in Indiana? ❑Yes No current year? Yes 0 No A person is not entitled t is deduction unless the person has a balance on the person's mortgage or n 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 rtor County ./'� Date(moon da ,year)
1��f L�1(1,5 \�O ) d R, 2,-2--
I/We certify under the penalty of perjury t t the above and foregoing information is tru \a d correct and that the applicant is resttt ent of Indiana and
• owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month.day,year)
011 //JQ "4- 1S-2
• Full residen address of art n (number and street.city.state.and ZIP code)
• 117 W Glendale St,Princeton,IN 47670
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,,-•--"