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�•:. , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a '` FOR DEDUCTION FROM ASSESSED VALUATION Q2� 2022
r. �" State Form 43709(R14/1-20) R. •_:EiV E Gibson
;a,.-V Prescribed by Department of Local Government Finance
NOV 0 1022 File Mark
INSTRUCTIONS:To be filed in person or by mail. ,l,�,C ' � �f ii . t 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)
ERRIN NICHOLE MASON and JONATHAN E.MASON Record number Page numb�"[[[
Taxing District �� Key number/legal description �p2 2— ��-6 J•
26-12-17-104-002.387-0 28
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is thl e a plic nt the sole
assessment date,current year assessment date,current year date of application
176,739.00 [ es ❑ No
If no,what is his/her exact share of interest'? owned with someone other than spouse,indicate with whom
ILED property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: Is th Zeal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller NOV 1.1 ZOZZ
FAIRWAY INDEPENDENT MORTGAGE CORPORATION
Address of mortgagee or contract seller(number and street,city,state.an d ZIP Code) .� _ )
4201 Marsh Lane,Carrollton,TX 75007 `/y,)„�,-'' COUNTY P►1rOR
Name of assignee or other owner or holder of mortgage
GIBSUN
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in ny If yes,what county? I What Taxing District? I Has this 1 n b n requ=?r• I If yes,state amount of deduction
on property for G 0
other county current year? Yes
in Indiana? ❑Yes No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c ract in•ebtedness 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 I 20 I 20 I 20 I 20
Signature of County Audito1A
_
�ypeju County `� I Date` nth, y,year)c�
_ t0 2 Lt
I/We certify under the penalty oofJ perjury
ytthat the above and foregoing information is tku�and correct and that the applicant's a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. I Date(month,day,year)
-p
ignature(owner' e) - (/j/)n n ,„4,) October 17,2022
Full residide address of applicant(number and street,city,state,and ZIP code)
E Ohio Street,Princeton,IN 47670-8702 Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 October 17,2022
Address of authorized person (number and street,city,state,and ZIP code)