HomeMy WebLinkAboutMortgage_Cowan .0•"'' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i ; FOR DEDUCTION FROM ASSESSED VALUATION Gibson Washington 2022
m , State Form 43709(R14/1-20) RECEIVED
Prescribed by Department of Local Government Finance
QT DEC 1 9 2022 File Mark
INSTRUCTIONS: To be filed in person or by mail. I\ FQrm filed with:
Filing Date: Form must be completed and dated in the cal year for which the deduction is sought. Iounty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prope
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)
Christopher Tyler Cowan
Taxing District Key number/legal description Record number Page numbpr
Washington 26-05-57-104-003.896-017/Pt Don 104-1-10(1.389 ac) 22 53.6('4
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 leg or stable owner?
$38,650.00 $199,485.00 or
0 No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: - •, in question:Annually Assessed
F I it e •erty 0 Annually Assessed
al---,/.'A, .1 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third Bank,National Association, ISAOA DEC 2 12022
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Kingsley Dr. Md:1 moba8,Cincinnati, OH 45227 � �I
Name of assignee or other owner or holder of mortgage Llcr.-
/ 72
GIBSON ;;,OUNT'r AUDITOR
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 deducti be quested If yes,state amount of deduction
other county on property for Yes 0 No
in Indiana? 0 Yes 0 No current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract 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 Q 20 20 20 20
Signature of County Auditor County Date yeacr�� � Gibson l 7iinonthry,
� v�'
II We certify under penalty of perjury that the above and foregoing Information Is true and correct and that the applicant is a redentIndiana and
owner/contract buyer of the aforementioned property on date application is flied.
Signature s full ns full n 1 -------_._ -- mr(J � b �-
Fu resident address of applicant(number and street,city,state,and ZIP code)
4651 N SR 65, Patoka, IN 47666
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 CONTRACT INDEBTEDNESS
Name of applicant Order No. Name of mort agee or contract seller
Christopher Tyler Cowan 22-2089 F T Fift TT�1i Bd ik, National Association, ISAOA
Date filed(month,day,year) i
�I, Amount of indebtedness1 �'� DiI"LfZL w 2 Z Washin ton Regional Title Services
ll $199,485.00 C� g ^� �,t
Key number/legal description D E C 2 12022 d,Q,Z t ^ S-3 `
26-05-57-104-003.896-017/Pt Don 104-1-10(1.389 a •
Signature of County Auditor/County Recorder County Date(month,day,year) L •
W1lliulk.ly,s � � 0, it G " C N.. F,„ RECEIVED
GIBSON COUNTY AL'.:,i
DEC 1 9 2022