HomeMy WebLinkAboutMortgage_Sailer (2) T"=""' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
a,r " •,,` ,. '1!;1 FOR DEDUCTION FROM ASSESSED VALUATION RECEIVED Gibson 024 2022
State Form 43709(R14/1-20)
Prescribed by Department of Local G nment Finance NOV2 3 2022
�__ File Mark
INSTRUCTIONS: To be filed in person or by mail. ` .SL 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. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Rick Sailer and Margaret Sailer
Taxing District Key number/legal description rd n r Page number
Fort Branch 26-19-19-101-000.657-026/CLA RENCE TERRACE SEC B 16 5( Q
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 stable owner?
$0.00 $193,800.00 J Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
FD
If name on record is different than that of applicant,indicate below: 7 i Is the perty in question:Annually Assessed
1 L ��--y/ ❑ eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third Bank, National Association DEC 01 2022
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Kingsley Drive, MD:1MOBA8, Cincinnati,OH 45227 ��` a. ..tiri ,
Name of assignee or other owner or holder of mortgage
GIBSON COUNTY AUDITOF.
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in If yes,what county? What Taxing District? Has this deductio b n requested If yes,state amount of deduction
other county 0 Yes No on property for
in Indiana? current year? Yes ❑ No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ont ct 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
Signature of County Auditor County Date( nth,çjlear)
rykupicSivi)I I We certify under penalty of perjury that the a•• nd foregoing information Is true and correct and that the applicant is a rest ent diana and
owner/contract buyer of the aforementioned property on date application Is filed.
Signature(own 11 n e) W2 D to(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code)
601 E.Oak 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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.