HomeMy WebLinkAboutMortgage_Carter (4) .c4".4 ,A , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
\* FOR DEDUCTION FROM ASSESSED VALUATION
>�� �F State Form 43709(R11 6-09) RECEIVED Gibson Fort Branch 2022
•y ,:a/ Prescribed by Department of Local Government Finance
1 5 2022
INSTRUCTIONS: 1 J NOVI File Mark
To be filed in person or by mail. �^
Filing Dates: 1.) Real Property: Must be completed and dated in the le dar year for which the deduction is sought. Form filed with:
Must be filed with the County Auditor or County Records f th county where the property is located
on or before January 5 of the immediately succeeding calendar year. 0 County Auditor
2.) Mobile/Manufactured Home not assessed as real Property: Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the ❑ County Recorder
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer—see restrictions on reverse side) (U Z 6
* Ashlei Kay Carter •
Taxin n Key number/legal descriptio // „ r)HCJ �.\t,_OO(0 f 23 _ Record nu�tver Page number
*Lot 22PT/23PT, a b ` A� 40 L - LI g r
Assessed value of real property as of Mortgage/Contract indebtedness unpaid Mortgage/Contract indebtedness Is the applicant the sole
March 1,current year as of March 1,current year. unpaid as of date of application legal or equitable owner?
$0.00 *$0.00 •$90,862.00 El Yes 0 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
0 Real Property 0 Annually Assessed
F ILMobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
* Fifth Third Bank,National Association
Address of mortgagee or contract seller(number and street, city,state,and ZIP code)
* 5001 Kingsley Drive,MD:1MOBA8,Cincinnati,OH 45227 DEC U 1 2022
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and street, city, state, and ZIP code) % a, Y(r
GIBSON COUNTY A �
Does applicant own property in any other In yes,what county? What Taxing District. Hi�rthis deduction been requested on property
county in Indiana? Tfor current year?
❑ Yes 0 No Yes 0 No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County its County \y'c)
^ Dated nOtl, a� eeLar)
I/We certify under the penalty of perjury that theabove and foregoing information isnd correct and that the applicant i a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's fullnarPe) Date(month,day,year)
4- ��4f.`r�_ 11/08/2022
Full resident address of applicant(number and street, city, state,and ZIP code)
203 E.South Street,Fort Branch, IN 47648
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)