HomeMy WebLinkAboutMortgage_Cross (4) .,„ __z,4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�d FOR DEDUCTION FROM ASSESSED VALUATION
N51 � State Form 43709(R14/1-20) RECEIVED Gibson Montgomery 2023
� •, Prescribed by Department of Local Government Finance
INSTRUCTIONS:To be filed in person or by mail.Car ^61
I AUV 1 1 2022 File Mark
orm fi d 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)
Shelley R.Cross
Taxing District Key number/legal description Record number Page number
021 26-11-19-400-000.847-021/PT E SE 19 2 11 3.34 AC D-14,Gibson County doda,pntx). ,y5—
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is Is the ape lu able owner?ant the sle
assessment date,current year assessment date,current year date of application 9 q
124,242.00 ® 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: Is the property in question:Annually Assessed
F��T Real Property ID Annually Assessed(IC 6-1.1-7)
Name of mortgagee or contract seller 1rJ
Regions Bank DBA Regions Mortgage AUG1 71 2022
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
2050 Parkway Office Circle,Hoover,AL 35244
Name of assignee or other owner or holder of mortgage ,j/1j, ytd
GIBSON COUNTY AUDITO
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 deducti en requested If yes,state amount of deduction
on property for
other county in Indiana? ❑Yes o current year? Yes ❑No
A person is not entitled thi deduction unless the person has a balance on the person's mortgage or ntract indebtedness that is recorded in the county
recorder's office(inc ding any home equity line of credit that is recorded in the county recorder's offic at 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 Date on a' G—.
fyl
Ak.
I/We certify under the penalty of perjury that the above and foregoing information is true nd correct and that the applicant is a re 'dent of Indiana and
ow•er/contract buyer of the aforementioned property on date application is filed.
Sig ur (ow full nam ' �� Date(month,day,year)
/���j�;yL1/' 8/4/2022
Full resident address of applicant •m er and street,city,state,and ZIP code)
2282 Old State Road 65 Owensville, IN 47665
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
8/4/2022
Address of authorized person (number and street,city,state,and ZIP code)