HomeMy WebLinkAboutMortgage_Collins (13) -rl STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r/ FOR DEDUCTION FROM ASSESSED VALUATION
l\ ., State Form 43709(R14/1-20) Gibson Patoka Township 2022
..;;' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. IZI 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. El County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Andrew&Angela Collins
Taxing District Key number/legal description Record nu er Page number
Patoka Township 26-12-09-400-000.332-027 �7�0 Z (I 4 Z
•
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 equitable owner?
$40,000 IZIYes ❑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: Is the property in question:Annually Assessed
®Real Property El Annually Assessed
M
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Liberty Federal Credit Union
_....-_467r)
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
O�/
i 9 2022 `
Address of assignee(number and street,city,state,and-ZIP code) l'`fBS 0 ( l�[ _ C�
N COUQ�,g�� (Vti�__)
Does applicant own pro' ( /tp,u) CAL, • i :? Has this deduction been nil "-AEA'AEA'yes,state amount of deduction
other county / `' `�"'� -��� on property for O�
in Indiana? ❑Yet current year? ®Yes El No
A person is not entitle e person's mortgage or contract indebtedness that is recorded in the county
recorder's office(Inc, D I Z���'1' �T O... �,c?o?. .county recorder's office)that is the basis for the deduction.
f AUDITOR
Deduction approved in Ca I'd NO. (,T8,t a
20 OT 20 20 20
I
Signature of County Auditor •. J County Date(month,day,year)
v--.Loalloal a""'"'..) Gibson 10/19/2022
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) VV'!�'*_ � Date(month,day,year)
'!4 10/19/2022
Full resident address of applicant(number and street,city,state,and ZIP code)
1877 Outer Lake Road, Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
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 CONTRIt1 I t� EDNESS
Name of applicant Name of mo Air.co actase
Andrew &Angela Collins Libe d al'Credit Unon
Date filed(month,day,year) Amount of indebtedness TIMrpTistrict
10/19/2022 $40,000 _ C� 19 oka Township
Key number/legal description 1 1
09-400d0003 d R'�Signatureo CmyReer County �e pw'Daate(month,day,year)
4-1,PANf_ Q 0•VD oLA l m Gibson.mr,i,c ovN1 10/19/22
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