HomeMy WebLinkAboutMortgage_INC (3) ��" 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°' {` FOR DEDUCTION FROM ASSESSED VALUATION
�01. .iil State Form 43709(R14/1-20) Gibson 02-q 2022
\?--- Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. -me_ I ; C c YI t( Z 1_// .
Fom- 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 354 County Auditor
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. E County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
PEPPERS INVESTMENT LLC
Taxing District Key number/legal description Record number Page number
V IS ' 26-12-07-401-001.808-028 2D 2 2-- 2 6(C r
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 legal or eTiltable owner?
193,200.00 DI Yes ❑ 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: L
F Is t property in question:Annually Assessed
Real Property ❑ Annually Assessed
���••/// Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
BRIGHTON BANK OCT 2 4 2022
Address of mortgagee or contract seller(number and street,city.state.and ZIP code)
7663 U.S.51,Brighton,TN 38011 c-_ ,,,,,,e /J �.. )
Name of assignee or other owner or holder of mortgage Gf gSON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code) (�
Does applicant own property in a If yes,what county? What Taxing District? Has this dedu\c`ti'^Jn be n reque d If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? Yes No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or o act 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 of County Auditor County Date(miff?,da year)
N1�c, a �(�\�v `Q�2141,02Z
I/We certify under the penalty of perjury that the above and foregoing information is t[Yte and correct and that the applicant is a resi ent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full na Re.
Date(month,day,year)
A �� June 3,2022
Full resid nt a dr ss o ap nt(number and street,city, a code)365-3ntfar Street,Elbe eld, IN Orb I3-aZ i2-' 3(4 5 P Rl H Ce ST.) PRt NI CG-'ro/J( t l..) 4 C, 10
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
June 3,2022
Address of authorized person (number and street,city,state,and ZIP code)