HomeMy WebLinkAboutMortgage_Embree (3) 4"""" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
at` 't - FOR DEDUCTION FROM ASSESSED VALUATION RECEIVED Gibson 0 Z 6 2022
State Form 43709(R14/1-20)
• • Prescribed by Department of Local Government Finance NUV 2022
�)/� �— 2 File Mark
INSTRUCTIONS: To be filed in person or by mail. 11�j � F rm 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. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Nathan C. Embree and Denise Wilson
Taxing District Key number/legal description Record number Page number
Fort Branch n ? 219PT/2 8PT PT NE 24 3 26-18-24-201-000.87-026 181 .0571/ACGRANGE ENLG Z 2— ( icf5
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?
$0.00 $198,550.00 yYes 0 No
If no,what is his/her exact share of interest? If owned with someone other thanspouse,indicate with whom
If name on record is different than that of applicant,indicate below: I TL T ■ ` Is the property in question:Annually Assessed
�-1/ ,A *Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
BNC National Bank Mortgage DEC 01 2022
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
7007 College Blvd,Ste 600,Overland Park, KS 66211 Name of assignee or other owner or holder of mortgage //'/7<clfa1-1 a ,
GIBSON COUNTY AUDITOF
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deductio en requested If yes,state amount of deduction
other county `r/r on property for Yes Cl No
in Indiana? ❑Yes NO current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or on 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)tha is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Audi , p _ •ove
County Date( nth, a-j,�yea
Gibson I ZQ1 v"' r)
ZZ�
I/We certify under penalty of perjury that and foregoing information is true and correct and that the applicant is a resident Indiana and
owner/contract buyer of the aforementioned property on date app' ation is filed.
Signature(o er's full name) _ Date(mintld.ey,year)
Full rest-dent address of applicant(number and street,city,state,and ZIP code)
405 S.Victor St., 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)
The penalties for oeriury can include imorisonment un fn two and a half veers anri a fine not to exceed$10,000.