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HomeMy WebLinkAboutMortgage_Cultice ^• ,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ; County Township Year xy k , FOR DEDUCTION FROM ASSESSED VALUATION i Gibson Q tCc 2022 w Ifi State Form 43109(R141 1-20) RECEIVE Prescribed by Department of Local Government Finance 7 q File Mark INSTRUCTIONS: To be filed in person or by mail. 1 1TlI e L St,�,�,.fla 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. 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. Jounty Recorder See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) ---J • • BRIANNA M.CULTICE and RUDY A.ZARATE ITaxing District Key number!legal description I Re�corrd renumber Page number ©n26-02-59-033-000.172-019 - 2_2._• Z Sck Assessed value of real property as of I Mortgage!Contract indebtedness unpaid as of I Mortgage/Contract indebtedness unpaid as of I Is the applicant the sole assessment date,current year 1 assessment date,current year j date of application !legal or equi le owner? I I Yes 0 No 143,920.00 1 If no,what is his i her exact share of interest? if owned with someone other than spouse,indicate with whom • than � E� _ If name on record is different Than that of applicant,indicate below: �is th roperty in question:Annually Assessed ', Real Property [�I Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller 0 C T 1 4 2022 _SPRINGS VALLEY BANK 8 TRUST COMPANY _ _ I Address of mortgagee or contract seller(number and street,city,state.and P ode) /J �,�/�� •{ 1500 Main Street,Jasper.IN 47546 (7i. .I/Y�2`.�Ln —— !Name of assignee or other owner or holder of mortgage GIBSON COUN fY AUUITO • Address of assignee(number and street,city,state,and ZIP code) • • ~Does applicant own property iy If yes,what county? What Taxing District? Has this dedu - b n requ If yes,state amount of deduction 1 oth on property for in Iner dianacounty _? Li Yes C No current year? Yes A person is not entitled to this deduction unless the person has a balance on the person's mortgage or n ct ind tedness 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 th t is the asis for the deduction. COUNTY AUDITOR Deduction approved in the amount of. • • I 20 1 20 1 20 20 I 20 20 20 I Signature of County Auditor County Date(month,day,year) 1 I/We certify under the penalty of perjury that the above and foregoing information is tru d correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date applicatio is filed. [ Signature(owner's f name) Date Date(month.day,year) �! 1 May 27,2022 • • Full resident address of app icant(number and street.city,state,and ZIP ode) • • 405 E 2nd Street,Hazleton,IN 47640-8830 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 'Date(month,day,year) i May 27,2022 Address of authorized person (number and street,city,state,and ZIP code) 1 The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. r� RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS a Name of applicant Na f mortgagee or Fogtract gOtier k BRIANNA M.CULTICE and RUDY A.ZARATEV(_,-Mel.' Date riledjmonth,dayy.year) Amount of indebtFsi El'r) Taxi Istrictt O U,—l\`�� Vv G� 0 kgm 1 i Key number!legal description y ,1 4 2022 m 1 26-02-59-033-000.172-019 OCT 1 Signature of County Auditor f County R�}c'o�rlderl0 countyk. Date(month.day year) ry L_ GIBSON COUNTY A TOF