Loading...
HomeMy WebLinkAboutMortgage_Heath (2) y,-FrAr,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year 4/ ". FOR DEDUCTION FROM ASSESSED VALUATION \ /. State Form 43709(R14/1-20) Gibson Montgomery 2022 Prescribed by Department of Local Government Finance File Mark INSTRUCTIONS: To be filed in person or by mail. For sled 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. ❑ ounty Recorder See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Andrea C. Heath and William D. Heath Taxing District Key number/legal description Record number Page number Montgomery 26-11-31-300-004.257-021 c Oc2QOO 5l88 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? $19,100.00 $273,500.00 $150,000.00 t Yes ❑No If no,what is his/her exact share of interest? If owned with someone other than spouse,i icate with whom If name on record is different than that of applicant,indicate below: the property in question:Annually Assessed Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) NamFirof National nalor act eller JFirst National Bank of Carmi Address of mortgagee or contract seller(number and street,city,state,and ZIP code) F, D 201 E. Main St., Carmi, IL 62821 1 Name of assignee or other owner or holder of mortgage C J� DEC 2022 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 deGd I8Tion FAIN rYdAtIlniercelkate amount of deduction other county on property for in Indiana? ❑YesWo current year? Yes No A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cont ct inde edness 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 20 Signature of County Auditor County Date(month,day year) `G�� ��'� Gibe7r1 gal r I,We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a res dent of Indiana and owner/contract buyer of the aforementioned property on date application is filed. Signature natu (owner's full nam -`L Date(month,day,year) (\ 11-25-2022 ull resident address of applicant(num e and street,-city state,and ZIP code) 6320 W Stalheim Ave, Owensville, IN 47665 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.