HomeMy WebLinkAboutMortgage_LLC (12) ""°.Q. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION RECEIVED Gibson _Petoka 2022
State Form 43709(R14/1-20)Prescribed by Department of Local Government Finance
AUG1 B 2022 File Mark
INSTRUCTIONS: To be filed in person or by mail. e--4y1 v"v-\ Form filed with:
Filing Date: Form must be completed and dated in the calend year for which the deduction is sought. \C unty Auditor
Must be filed or postmarked with the County Audi or 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. Egi County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
JDA Development LLC
Taxing District `tO Key number/legal description Record n2m2- Page numb
er
Patoka I 26-12-07-202-001.013-028 INS Lot 4 Pt R2 (� J!6 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 legs or equitable owner?
$74,700.00 $50,582.50 Yes 0 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: I the property in question:Annually Assessed
eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Legence Bank,its successors and assigns T T"LED
Address of mortgagee or contract seller(number and street,city,state,and ZIP c l�,- 1
Name of assignee or other owner or holder of mortgage
AUG 18 2022
Address of assignee(number and street,city,state,and ZIP code)
•
Does applicant own property in any If yes,what county? What Taxing dl '�?_.t / �, a ' ' b en requested If yes,state amount of deduction
other county 0 Yes No ,GIrBSO+N COI tf'P>irOO Yes 0 No
in Indiana? current year?
A person is not entitled o this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(inclu ing 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 pi County Dat pt ay,year
Gibson ll// yr^^J 2'�
I/We certify under penalty of perjury that the above and foregoing Information Is true and correct and that the applicant Is a res ant Indiana and
owner I contract buyer of the afore ention d pro rty on date application Is filed. //
Signature(owner's full name) 9 /7 Date L �h,4�t,year)
DreFull resident address of applica number and street,city,state,and ZIP code l/�J 8 JVt't/l//C7/
701 E Spruce Street rinceton, IN 47670
Person authorized by dul 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)
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