HomeMy WebLinkAboutMortgage_Michels (3) 7.-t^µ _a,{ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i<< I FOR DEDUCTION FROM ASSESSED VALUATION
(`�` ��' State Form 43709(R14/1-20) Gibson U^; 2022
;01-_j7 Prescribed by Department of Local Government Finance l `
File Mark
INSTRUCTIONS:To be filed in person or by mail.
Form filed 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. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
KEVIN D.MICHELS
Taxing District Key number/legal description Record number Page number
V r 26-18-24-101-002.415-025 6 a 39914
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applican a sole
assessment date,current year assessment date,current year date of application legal or equi le owner?
140,008.00 es ❑ 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 th property in question:Annually Assessed
al Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
CALIBER HOME LOANS INC. L {FIT 1 D
Address of mortgagee or contract seller(number and street,city,state.and ZIP code) L�...+
1525 S Beltline Road,Coppell,TX 75019
Name of assignee or other owner or holder of mortgage
SEP 3 0 ?fl?
Address of assignee(number and street.city,state,and ZIP code) ��
Does applicant own property in y If yes,what county? What Taxing District? Has this deduction been f gs sNfutt�deduction
other county on property fort N COUNTY AUDITOR
in Indiana? El Yes LLL]]]��V No current year? LI Yes No
A person is not entitled to 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(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 ofreCor County Date(month.day,year)
�,d r �� Soh Date
?'
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
natur (owner's full name) Date(month,day,year)
August 26,2022
Fu esident address of applicant number and street,city,state.and ZIP code)
8130 S Angelia Drive,Fort Branch,IN 47648-8075
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
August 26,2022
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$10,000.