Loading...
HomeMy WebLinkAboutMortgage_Hernandez (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 1e %, FOR DEDUCTION FROM ASSESSED VALUATION I — L - e 3 t' I„ State Form 43709(R14/1-20) RECEIVE Gibson © rL1 2022 �% Prescribed by Department of Local Government Finance File Mark INSTRUCTIONS: To be filed in person or by mail. iy,eG 1 i' t O -Scvi(e.j O C T 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. County Recorder See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) LUIS ANTONIO GARCIA HERNANDEZ Taxing District 1 Key number/legal description Record number Page number 26-17-21-200-004.715-021 l-o7 L �)-Lk5 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,current year date of application legal or equitabl wner? 60,000.00 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: FILED Is the property in question:Annually Assessed rJ',d'Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller FIFTH THIRD BANK,NATIONAL ASSOCIATION OCT 1 4 2022 Address of mortgagee or contract seller(number and street,city,state.and ZIP code) 5001-Kingsley Drive,MD:1MOB2X,Cincinnati,OH 45227 Name of assignee or other owner or holder of mortgage e 1)2,,A.y[ G•G. .4,..4rwir4 GIBSON COUNTY AUDITOP Address of assignee(number and street,city,state,and ZIP code) Does applicant own property i ny If yes,what county? What Taxing District? Has this deductio a equ s d If yes,state amount of deduction other county on property f r in Indiana? ❑Yes No current yea Yes No A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract in a edness 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 b is for the deduction. COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of County Auditor County 1 Date(mo th,da year) Vi--\ 30JAA—Nltl-S (C4j ,__. 1 1 0 1 LA 20 22-- perjury that the above and foregoing information is true correct and that the applicant i�a resi ent of Indiana and I/We certify under the penalty of p ) ry 9 9 owner/contract buyer of the aforementioned property on date application is filed. gnature(owner's full name) Date(month,day,year) Lois 64 GGIiC 14 NGY y1Gvf AG L January 28,2022 Ful resident address of applicant(number and street,city,state,and ZIP code) 9794 W 800 S,Owensville,IN 47665-8878 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) January 28,2022 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. RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Name of applicant my; 0 ontr sellLUIS ANTONIO GARCIA HERNANDEZ " 73 Date filed(month,day,year) Amount of indebtedne Taxing District 0 In�1�"��2Z so,000.o0 1 O'L� m Key number/legal description In;I 4 2022 ^2� �� ,� ,• m 26-17-21-200-004.715-021 !- , ▪ 0 Signature of County Auditor/CounYoWr -1 �„1) !/ Tfullt; Date(month,d�y,y r) ��lety r„ ZGIBSON COUTO