HomeMy WebLinkAboutMortgage_Runyon •- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co,_r i Tb p, T Year
zd..e'c". :" FOR DEDUCTION FROM ASSESSED VALUATION 0
2�
x, 1; State Form 43709(R14/1-20) Gibson 2022
Prescribed by Department of Local Government Finance RECEIVED
,----- File Mark
INSTRUCTIONS:To be filed in person or by mail. 1�L�1 IAc �a OCT 1 1 2022 Form filed 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)
DARLENE RUNYON
Keynumber/legal description Record number Page number
Taxing D trict /� 6 9 -2. 0 2_ •2 0 S-0
�``/�Z(p • 26-19-19-103-001.200-026 !/ C�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is t applicant
the e sole?
assessment date,current year assessment date,current year date of application legal �q
184,000.00 I_Ls ❑ No
If no,what is his/her exact share of interest? ILE If owned with someone other than spouse,indicate with whom
Is the operty in question:Annually Assessed
If name on record is different than that of applicant,indicate b I Property ❑ Annually Assessed
111111------ p Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller OCT
1 4 ZOZZ
GERMAN AMERICAN BANK �►�t� .A/
Address of mortgagee or contract seller(number and street,city/ r wand ZIP ege) te..Lam.
PO Box 360,Jasper,IN 47547-0360 GlBgO►d COUNTY AUDITC
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state,and ZIP code) ////////����
What TaxingDistrict? Has this deduc-e n re ed If yes,state amount of deduction
Does applicant own property in a If yes,what county? on property for
other county current year? Yes o
in Indiana? El Yes O
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or o act ind btedness 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 asis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
County4 _ Date(m nth.d year)r�
Signature of County Auditor e(AV iO [Li -7j ) C. ZI/We certify under the penalty of perjury that the above and foregoing information is tru)riL--W1
d correct and that the applicant s a r ident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Date(month.day,year)
Signat owner's full name)
\, It�n: / ,^, April 25,2022
/XPuul resident address of applicant(number and feet,city,state.and ZIP code)
7950 S Andee Lane,Fort Branch, IN 4 8-1545 Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
April 25,2022
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 S10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant fgee or co tract seller ))
, \ O�1� P�.C C'Lln Vim. - o
DARLENE RUNYON E i J�,- 1z./' Taxing District - m
33
Date filed(month,day,year) Amount of ind do �J t`�1J J
(1_1 y-- 22 184,000.00 M
rn
Key number/leg descriptionde_ OCT 1 4 2022 rJ �� o m
26-19-19-103-001.200-026 / DateSm�n'h,da,year) V
Signature of County Auditor/CountyRecorder r „ C-Cj\
� e%�r: ty {U ♦�
�( , �� .u. n l 20 2Z
GIBBON COUNTY '�